Validation and Adaptation of the Multidimensional Prognostic Index in an Older Australian Cohort.

Kimberley Bryant,Arduino A Mangoni,Richard J Woodman,Michael J Sorich

doi:10.3390/jcm8111820

Kimberley Bryant, Arduino A Mangoni + Show 2 more

Open Access

https://doi.org/10.3390/jcm8111820

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Abstract

Background and aims: The Multidimensional Prognostic Index (MPI), an objective and quantifiable tool based on the Comprehensive Geriatric Assessment, has been shown to predict adverse outcomes in European cohorts. We conducted a validation study of the original MPI, and of adapted versions that accounted for the use of specific drugs and cultural diversity in the assessment of cognition, in older Australians. Methods: The capacity of the MPI to predict 12-month mortality was assessed in 697 patients (median age: 80 years; interquartile range: 72–86) admitted to a metropolitan teaching hospital between September 2015 and February 2017. Results: In simple logistic regression analysis, the MPI was associated with 12-month mortality (Low risk: OR reference group; moderate risk: OR 2.50, 95% CI: 1.67–3.75; high risk: OR 4.24, 95% CI: 2.28–7.88). The area under the receiver operating characteristic curve (AUC) for the unadjusted MPI was 0.61 (0.57–0.65) and 0.64 (95% CI: 0.59–0.68) with age and sex adjusted. The adapted versions of the MPI did not significantly change the AUC of the original MPI. Conclusion: The original and adapted MPI were strongly associated with 12-month mortality in an Australian cohort. However, the discriminatory performance was lower than that reported in European studies.

Highlights

The global population is continuously expanding and ageing as a result of significant advances in human health and favourable economic conditions [1]
No difference in patient characteristics was observed in the 40 patients lost to follow-up compared to the included patient cohort (n = 697) (Supplementary Table S1)
Most patients were included in the moderate Multidimensional Prognostic Index (MPI) risk category (57.8%) while a third were in the mild risk category (33.9%) and a relatively small proportion in the severe risk category (8.3%) (Table 1)

Summary

Introduction

The global population is continuously expanding and ageing as a result of significant advances in human health and favourable economic conditions [1]. This phenomenon imposes significant public health and financial challenges [2]. We conducted a validation study of the original MPI, and of adapted versions that accounted for the use of specific drugs and cultural diversity in the assessment of cognition, in older Australians. Methods: The capacity of the MPI to predict 12-month mortality was assessed in 697 patients (median age: 80 years; interquartile range: 72–86) admitted to a metropolitan teaching hospital between September 2015 and February 2017. The discriminatory performance was lower than that reported in European studies

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Discussion

Conclusion