title: The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study.
abstract: BACKGROUND
  prediction of length of stay (LOS) may be useful to optimise care plans to reduce the negative outcomes related to hospitalisation.
  
  
  OBJECTIVE
  to evaluate whether the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), may predict LOS in hospitalised older patients.
  
  
  METHODS
  prospective multicentre cohort study.
  
  
  METHODS
  twenty Geriatrics Units.
  
  
  METHODS
  patients aged 65 and older consecutively admitted to Geriatrics Units.
  
  
  METHODS
  at admission, the CGA-based MPI was calculated by using a validated algorithm that included information on basal and instrumental activities of daily living, cognitive status, nutritional status, the risk of pressures sores, co-morbidity, number of drugs and co-habitation status. According to validated cut-offs, subjects were divided into three groups of risk, i.e. MPI-1 low risk (value ≤0.33), MPI-2 moderate risk (value 0.34-0.66) and MPI-3 severe risk of mortality (value ≥0.67).
  
  
  RESULTS
  two thousand and thirty-three patients were included; 1,159 were women (57.0%). Age- and sex-adjusted mean LOS in patients divided according to the MPI grade was MPI-1 = 10.1 (95% CI 8.6-11.8), MPI-2 = 12.47 (95% CI 10.7-14.68) and MPI-3 = 13.41 (95% CI 11.5-15.7) days (P for trend <0.001). The overall accuracy of the MPI to predict LOS was good (C-statistic 0.74, 95% CI 0.72-0.76). Moreover, a statistically significant trend of LOS means was found even in patients stratified according to their International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) main diagnosis.
  
  
  CONCLUSIONS
  the MPI is an accurate predictor of LOS in older patients hospitalised with the most frequent diseases.
authors.affiliation: Department of OrthoGeriatrics, Rehabilitation and Stabilization, E.O. Galliera Hospital, Genova 16128, Italy Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pilotto
authors.affiliation: Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Sancarlo
authors.affiliation: Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.affiliation: Geriatric Department, Università Federico II, Napoli, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Rengo
authors.affiliation: Geriatric Department, Università di Firenze, Florence, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
authors.affiliation: Geriatrics Unit, University of Ferrara, Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpato
authors.affiliation: National Institute on Aging, Baltimore, MD, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D003071:Cognition; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007558:Italy; D007902:Length of Stay; D008297:Male; D017533:Marital Status; D015596:Nutrition Assessment; D009752:Nutritional Status; D010343:Patient Admission; D019338:Polypharmacy; D003668:Pressure Ulcer / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Multidimensional Prognostic Index; length of stay; mortality; older people