The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access originally published online on April 6, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2009 64A(8):880-887; doi:10.1093/gerona/glp031
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The Multidimensional Prognostic Index Predicts Short- and Long-Term Mortality in Hospitalized Geriatric Patients With Pneumonia
1 Department of Medical Sciences, Geriatric Unit and Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
2 National Institute on Aging, Longitudinal Studies Section, Harbor Hospital Center, Baltimore, Maryland
3 Biostatistics and Gastroenterology Unit, IRCCS "Saverio De Bellis," Castellana Grotte, Italy
4 IRCCS Casa Sollievo della Sofferenza—Mendel Institute, Rome, Italy
5 Department of Experimental Medicine and Pathology, University "La Sapienza," Rome, Italy
6 Gastroenterology Department, University of Parma, Italy
Address correspondence to Alberto Pilotto, MD, Department of Medical Sciences, Geriatric Unit and Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo, Foggia I-71013, Italy. Email: alberto.pilotto{at}operapadrepio.it
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Abstract |
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Background: Multidimensional impairment of older patients may influence the clinical outcome of acute or chronic diseases. Our purpose is to evaluate the usefulness of a multidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) for predicting mortality risk in older patients with community-acquired pneumonia (CAP).
Methods: This prospective study included 134 hospitalized patients aged 65 and older with a diagnosis of CAP. A standardized CGA that included information on clinical, cognitive, functional, and nutritional status as well as comorbidities, medications, and social support network was used to calculate MPI. The pneumonia severity index (PSI) was also calculated. The predictive value of the MPI for all cause mortality over a 1-year follow-up was evaluated and was compared with that of PSI.
Results: Higher MPI values were significantly associated with higher mortality at 30 days (Grade 1 = 3%, Grade 2 = 12%, Grade 3 = 44%, p < .001), 6 months (Grade 1 = 7%, Grade 2 = 21%, Grade 3 = 50%, p < .001), and 1 year (Grade 1 = 10%, Grade 2 = 33%, Grade 3 = 53%, p < .001). A close agreement was found between the estimated mortality by MPI and the observed mortality. MPI had a significant greater discriminatory power than PSI both at 30 days (area under the receiver operating characteristic [ROC] curve = 0.83 vs 0.71, p = .019) and 6 months (0.79 vs 0.69, p = .035), but not after 1 year of follow-up (0.80 vs 0.75, p = .185).
Conclusions: This MPI, calculated from information collected in a standardized CGA, accurately stratifies hospitalized elderly patients with CAP into groups at varying risk of short- and long-term mortality. The predictive accuracy of the MPI was higher than the predictive value of the PSI.
Keywords Multidimensional prognostic index; Comprehensive geriatric assessment; Pneumonia; Mortality; Elderly people
Received: July 1, 2008; Accepted: January 7, 2009