Mortality and readmission risk can be predicted by the record-based Multidimensional Prognostic Index: a cohort study of medical inpatients older than 75 years

Hansen, Troels Kjærskov; Shahla, Seham; Damsgaard, Else Marie; Bossen, Sofie Ran Lindhardt; Bruun, Jens Meldgaard; Gregersen, Merete

doi:10.1007/s41999-021-00453-z

Cited by 14 publications

(6 citation statements)

References 39 publications

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“…The MPI was performed during the first 48 h after admission whereas we performed the MPI at discharge. The predictive value of MPI for patients with CDI at discharge was in line with its value in other medical inpatients at time of discharge, showing an AUC for 90-day mortality of 0.76 [29]. The patients were older (≥ 75 years) and required daily assistance or had a Charlson Comorbidity Index ≥ 1, whereas patients in our study were included solely if they had a positive CDI test and were aged ≥ 60 years.…”

Section: Discussionsupporting

confidence: 72%

Frailty level at discharge predicts mortality in older patients with Clostridioides difficile more accurately than age or disease severity

et al. 2023

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Purpose Clostridioides difficile infection (CDI) has a high mortality among older patients. Identification of older patients with CDI in increased mortality risk is important to target treatment and thereby reduce mortality. The aim of this study was to investigate mortality rates and compare frailty levels at discharge, measured by the record-based Multidimensional Prognostic Index (MPI), with age and severity of CDI as mortality predictors in patients with CDI diagnosed during hospitalisation. Methods This was a population-based cohort study from Central Denmark Region, Denmark, including all patients ≥ 60 years with a positive CD toxin test without prior infection and diagnosed from 1 January to 31 December 2018. Frailty level, estimated from the electronic medical record, was defined as low, moderate, or severe frailty. CDI severity was graded according to international guidelines. Primary outcome was 90-day mortality. Results We included 457 patients with median age 77 years (interquartile range 69–84) and females (49%). Overall, 90-day mortality was 28%, and this was associated with age (hazard ratio (HR): 2.71 (95% confidence interval 1.64–4.47)), CDI severity (HR 4.58 (3.04–6.88)) and frailty (HR 10.15 (4.06–25.36)). Frailty was a better predictor of 90-day mortality than both age (p < 0.001) and CDI severity (p = 0.04) with a receiver operating characteristic curve area of 77%. Conclusion The 90-day mortality among older patients with CDI in a Danish region is 28%. Frailty measured by record-based MPI at discharge outperforms age and disease severity markers in predicting mortality in older patients with CDI.

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Section: Discussionsupporting

confidence: 72%

Frailty level at discharge predicts mortality in older patients with Clostridioides difficile more accurately than age or disease severity

et al. 2023

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“…We used the record-based MPI (rMPI) that includes eight domains with weighted scores to assess and divide the patient’s frailty level at admission into low as the non-frail patient group, and moderate and severe as the frail group (“ Appendix 1 ”) [ 19 , 24 ]. Furthermore, we used the CFS both at admission and at discharge to describe any functional decline in relation to the hospitalization (“ Appendix 2 ”).…”

Section: Methodsmentioning

confidence: 99%

Clinical presentation and outcomes of COVID-19 in older hospitalised patients assessed by the record-based multidimensional prognostic index, a cross-sectional study

et al. 2021

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Key summary points Aim Confusion was more prevalent in frail than in non-frail older patients at hospital admission. Finding COVID-19 and accelerated functional decline were associated among frail older hospitalised patients when compared to non-frail. Message Ninety-day all-cause mortality was 70% among frail hospitalised patients with COVID-19 and 15% among non-frail.

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“…The Multidimensional Prognostic Index (MPI), a prognostic tool in CGA, showed good discrimination and calibration for mortality of the elderly [48]. Based on a large prospective observational study by Pilotto et al, MPI showed only fair discrimination for predicting hospital readmissions, with a C-statistic of 0.65 [49]; and in a cohort study by Hansen et al it was reported that MPI had poorer discrimination for readmission compared to mortality, with a C-statistic of 0.59 for 30-day readmission and 0.76 for 90-day mortality [50]. It was speculated that functional decline and malnutrition might play less of a role in the short-term readmission of elderly patients after discharge compared to short-term or long-term mortality.…”

Section: Cga and Readmissionmentioning

confidence: 99%

Prediction of 30-Day Readmission in Hospitalized Older Adults Using Comprehensive Geriatric Assessment and LACE Index and HOSPITAL Score

Sun

Chou

Lee

et al. 2022

IJERPH

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(1) Background: Elders have higher rates of rehospitalization, especially those with functional decline. We aimed to investigate potential predictors of 30-day readmission risk by comprehensive geriatric assessment (CGA) in hospitalized patients aged 65 years or older and to examine the predictive ability of the LACE index and HOSPITAL score in older patients with a combination of malnutrition and physical dysfunction. (2) Methods: We included patients admitted to a geriatric ward in a tertiary hospital from July 2012 to August 2018. CGA components including cognitive, functional, nutritional, and social parameters were assessed at admission and recorded, as well as clinical information. The association factors with 30-day hospital readmission were analyzed by multivariate logistic regression analysis. The predictive ability of the LACE and HOSPITAL score was assessed using receiver operator characteristic curve analysis. (3) Results: During the study period, 1509 patients admitted to a ward were recorded. Of these patients, 233 (15.4%) were readmitted within 30 days. Those who were readmitted presented with higher comorbidity numbers and poorer performance of CGA, including gait ability, activities of daily living (ADL), and nutritional status. Multivariate regression analysis showed that male gender and moderately impaired gait ability were independently correlated with 30-day hospital readmissions, while other components such as functional impairment (as ADL) and nutritional status were not associated with 30-day rehospitalization. The receiver operating characteristics for the LACE index and HOSPITAL score showed that both predicting scores performed poorly at predicting 30-day hospital readmission (C-statistic = 0.59) and did not perform better in any of the subgroups. (4) Conclusions: Our study showed that only some components of CGA, mobile disability, and gender were independently associated with increased risk of readmission. However, the LACE index and HOSPITAL score had a poor discriminating ability for predicting 30-day hospitalization in all and subgroup patients. Further identifiers are required to better estimate the 30-day readmission rates in this patient population.

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Mortality and readmission risk can be predicted by the record-based Multidimensional Prognostic Index: a cohort study of medical inpatients older than 75 years

Cited by 14 publications

References 39 publications

Frailty level at discharge predicts mortality in older patients with Clostridioides difficile more accurately than age or disease severity

Frailty level at discharge predicts mortality in older patients with Clostridioides difficile more accurately than age or disease severity

Clinical presentation and outcomes of COVID-19 in older hospitalised patients assessed by the record-based multidimensional prognostic index, a cross-sectional study

Prediction of 30-Day Readmission in Hospitalized Older Adults Using Comprehensive Geriatric Assessment and LACE Index and HOSPITAL Score

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