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Validation of a Modified-Multidimensional Prognostic Index (m-MPI) including the Mini Nutritional Assessment Short-Form (MNA-SF) for the prediction of one-year mortality in hospitalized elderly patients.
D Sancarlo; G D'Onofrio; M Franceschi; C Scarcelli; V Niro; F Addante; M Copetti; L Ferrucci; L Fontana; A Pilotto (Profiled Author: Luigi Ferrucci)
Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
The journal of nutrition, health & aging 2011;15(3):169-73.
BACKGROUND: The mortality prediction represents a key factor in the managing of elderly hospitalized patients. Since in older subjects mortality results from a combination of biological, functional, nutritional, psychological and environmental factors, a Multidimensional Prognostic Index (MPI) that predict short- and long-term mortality based on a standardized comprehensive geriatric assessment (CGA) has recently been developed and validated. OBJECTIVE: This study compares the accuracy in predicting the mortality of the MPI with a modified version of the MPI (m-MPI) that included the Mini Nutritional Assessment-Short Form (MNA-SF) instead of the standard MNA. DESIGN: This prospective study with a one-year follow-up included 4088 hospitalized patients aged 65 years and older. A standardized CGA that included information on functional (Activities of Daily Living, ADL and Instrumental-ADL), cognitive (Short Portable Mental Status Questionnaire), risk of pressure sore (Exton-Smith Scale), comorbidities (CIRS Index), medications, living status and nutritional status (MNA and MNA-SF) was used to calculate the MPI using a previously validated algorithm. RESULTS: Higher MPI values were significantly associated with higher mortality rates with a close agreement between the estimated and the observed mortality both after 1-month (MPI1=2.8% versus m-MPI1=2.8%,p=0.946; MPI2=8.9% versus m-MPI2=9%,p=0.904; MPI3=21.9% versus m-MPI3=21.9,p=0.978) and 1-year of follow-up (MPI1=10.8% versus m-MPI1=10.5%,p=0.686; MPI2=27.3% versus m-MPI2=28%, p=0.495; MPI3=52.8% versus m-MPI3=52.7%,p=0.945). The estimated areas under the receiver operating characteristics (ROC) curves suggested a clinically negligible difference between the two indices. CONCLUSION: The m-MPI is as sensitive as the MPI in stratifying hospitalized elderly patients into groups at varying risk of short- and long-term mortality, but with fewer items.
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