title: Change in the Multidimensional Prognostic Index Score During Hospitalization in Older Patients.
abstract: We investigated and describe change in the Multidimensional Prognostic Index (MPI) score between admission and discharge in 960 older patients admitted to 20 geriatric units for an acute disease or a relapse of a chronic disease. The MPI was calculated at admission and at discharge. Subjects were divided into three groups of MPI score, low risk (MPI-1 value ≤0.33), moderate risk (MPI-2 value 0.34-0.66), and severe risk of mortality (MPI-3 value ≥0.67), on the basis of previously established cutoffs. Variation of MPI values over length of hospital stay (LOS) was analyzed with a multivariable longitudinal linear model for repeated measurements. At admission, 23.5% subjects had an MPI-1 score, 33.3% had an MPI-2 score, and 43.0% had an MPI-3 score. Overall, for almost 60% of the patients, MPI score at hospital discharge was different compared with the score at admission, although the difference was not statistically significant (-0.003; p = 0.708). Patients with high and intermediate MPI scores at admission had a decrease of MPI score at discharge (delta-MPI -0.026, p < 0.001, and delta-MPI -0.066, p = 0.569, respectively), whereas patients in the MPI-low group, experienced a significant increase in MPI score (delta-MPI 0.041, p < 0.001). The evolution of MPI score as a function of LOS had a curvilinear shape because it significantly decreased for patients with short hospitalization (1-6 days) and tended to increase for those with longer LOS. The MPI, a well-established prognostic tool, is sensitive to change of patient's health status and might be used to objectively track and monitor the clinical evolution of acutely ill geriatric patients admitted to the hospital.
authors.affiliation: 1 Internal Medicine Section, Department of Medical Science, University of Ferrara , Italy .
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpato
authors.affiliation: 2 Geriatric Unit, Azienda ULSS 16 Padova , Padova, Italy .|3 Geriatric-Gerontology Research Unit, Scientific Institute for Research and Care , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy .
authors.forename: Julia
authors.initials: J
authors.lastname: Daragjati
authors.affiliation: 2 Geriatric Unit, Azienda ULSS 16 Padova , Padova, Italy .
authors.forename: Matteo
authors.initials: M
authors.lastname: Simonato
authors.affiliation: 4 Unit of Biostatistics, Scientific Institute for Research and Care , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy .
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontana
authors.affiliation: 5 Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging , Baltimore, Maryland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.affiliation: 2 Geriatric Unit, Azienda ULSS 16 Padova , Padova, Italy .|3 Geriatric-Gerontology Research Unit, Scientific Institute for Research and Care , Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy .|6 Department of Geriatric Care, OrthoGeriatrics and Rehabilitation-Frailty Area, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genova, Italy .
authors.forename: Alberto
authors.initials: A
authors.lastname: Pilotto
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D016009:Chi-Square Distribution; D002908:Chronic Disease; D003071:Cognition; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007558:Italy; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D010343:Patient Admission; D010351:Patient Discharge; D019338:Polypharmacy; D011237:Predictive Value of Tests; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors