Background Multidimensional Prognostic Index (MPI) is useful as a prognostic tool in hospitalized older patients, but our knowledge is derived from retrospective studies. We therefore aimed to evaluate in a multicenter, longitudinal, cohort study whether the MPI at hospital admission is useful to identify groups with different mortality risk and whether MPI at discharge may predict institutionalization, rehospitalization, and use of home care services during 12 months. Methods This longitudinal study, carried out between February 2015 and August 2017, included nine public hospitals in Europe and Australia. A standardized comprehensive geriatric assessment including information on functional, nutritional, cognitive status, risk of pressure sores, comorbidities, medications, and cohabitation status was used to calculate the MPI and to categorize participants in low, moderate, and severe risk of mortality. Data regarding mortality, institutionalization, rehospitalization, and use of home care services were recorded through administrative information. Results Altogether, 1,140 hospitalized patients (mean age 84.1 years, women = 60.8%) were included. In the multivariable analysis, compared to patients with low risk group at admission, patients in moderate (odds ratio [OR] = 3.32; 95% CI: 1.79–6.17; p < .001) and severe risk (OR = 10.72, 95% CI: 5.70–20.18, p < .0001) groups were at higher risk of overall mortality. Among the 984 older patients with follow-up data available, those in the severe-risk group experienced a higher risk of overall mortality, institutionalization, rehospitalization, and access to home care services. Conclusions In this cohort of hospitalized older adults, higher MPI values are associated with higher mortality and other negative outcomes. Multidimensional assessment of older people admitted to hospital may facilitate appropriate clinical and postdischarge management.

Background: Older patients with cancer require specific and individualized management. The 3-group Multidimensional Prognostic Index (MPI) based on the Comprehensive Geriatric Assessment (CGA) has shown a predictive interest in terms of mortality. The objective of our study was to assess the prognostic value of MPI for 1year mortality in an external prospective French cohort of elderly patients with cancer. Methods: From March 2015 to March 2017 a prospective single-center cohort study enrolled all patients with cancer, aged 75 years and older referred to the geriatric oncology clinic. We used a proportional hazard model for 1-year mortality adjusted for age, sex, tumor sites and metastatic status. C-statistics were used to assess the incremental predictive value of MPI index to these risk factors. Results: overall, 433 patients underwent CGA with MPI (women 42%; mean age 82.8 ± 4.8 years). The most common tumor sites were prostate (23%), skin (17%), colorectum (15%) and breast (12%); 29% of patients had a metastatic disease; 231 patients (53%) belonged to the "MPI-1" group, 172 (40%) to the "MPI-2" group and 30 patients were classified in the "MPI-3" group. One-year mortality rate was 32% (23% in MPI-1, 41% in MPI-2 and 53% in MPI-3, p = 0.024). All domains of MPI except cognition and living status were significantly associated with mortality at one-year, as well as tumor sites and metastatic status. Higher MPI was associated with a higher mortality risk (adjusted HR 1.56 [95%CI 1.70-2.09] and 1.72 [1.33-2.22] for MPI groups 2 and 3 compared to 1; p < 0.0001). Conclusions: In addition to established risk factors, MPI improves risk prediction of 1-year mortality. This practical prognostic tool may help to optimize management of these vulnerable patients.

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Background: Myelodysplastic syndromes (MDS) are clonal hemopathies with a relatively heterogeneous spectrum of presentation and a variable risk of transformation into acute myeloid leukemia (AML). Autoimmune diseases (AID) are present in 10 to 30% of MDS, with uncertain prognostic significance in this context. To date, no MDS-related factor has been clearly identified as a predictor for the occurrence of AIDs. Aims: To study the association between MDS characteristics and the occurrence of an AID and its impact on overall survival and leukemia-free survival. Methods: We retrospectively collected data from primary MDS adult patients followed-up at the University Hospital of Poitiers between January 2010 and December 2017. Immunosuppressive therapy secondary-MDS were excluded. The date of onset and type of AID as established by the standard criteria were collected. Steroid dependence was defined as a prednisone equivalent amount > 10 mg/day during at least 3 months. Simultaneous diagnosis of MDS and AID were considered if established in a 3-months interval from the MDS one. Baseline characteristics at diagnosis of the MDS were registered and compared between those with and without AIDs. Results: AIDs were identified in 44 of 179 MDS patients (24.6%). MDS-AID patients were more frequently male (29/44, p < 0.05). AIDs occurred before MDS in 63.6% of cases. Associated AIDs were: systemic vasculitis (23%), inflammatory rheumatism (18%), neutrophilic dermatosis (12.5%), connective tissue diseases (12.5%) and autoimmune cytopenia (11%). At the time of AID diagnosis, 48% of patients had general signs, 37.5% had cutaneous and/or joint signs. AID was steroid-dependent in 39% of cases (9/23). No association between AID and MDS subtypes was observed. A significant linear tendency was found between the R-IPSS and the presence of AID (p = 0.02): that is, the lower the IPSS-R score, the higher the risk of association with AID. The presence of AID did not affect survival or progression to acute leukemia. Summary/Conclusion: The association of MDS to AIDs is frequent and of clinical heterogeneous expression. It occurs mainly in low-risk MDS and does not seem to impact overall survival, that seems logical. The pathogenic mechanisms are complex and remain still completely unknown, but the hypothesis of a common pathogenic pathway seems strongly supported. The association MDS-AID does not seem to impact overall survival in our cohort and occurs mainly in low-risk MDS with a significant linear augmentation of the risk by the creasing categories of R-IPSS. That raises the question of the role of different physio-pathological processes underlying low-risk and high-risk MDS in the predisposition of AIDs. Larger prospective ongoing studies will better clarify our results.