Outcome of the multidimensional prognostic index in ultra-octogenarian patients hospitalized for cardiovascular diseases

Abstract

Background: The multidimensional prognostic index (MPI) is a validated tool for prognostic stratification in acute and chronic setting of geriatric patients. However, only few data are available on patients with cardiovascular diseases.

Aim: To evaluate the potential role of MPI as predictor of 1-year and long-term outcome in ultra-octogenarians patients hospitalized for cardiovascular diseases.

Methods and results: We conducted a prospective study on 216 patients (mean age 85 ± 4 years) hospitalized for cardiovascular disease enrolled from September 2011 to February 2014 in both Cardiology and Internal Medicine Departments. The mean follow-up was 33 ± 7 months. The primary end-point was 1-year all-cause mortality. In addition, 3-year all-cause mortality was also assessed in the overall cohort and outcome prediction was then evaluated separately in patients with a primary diagnosis of heart failure and acute coronary syndrome. At admission, 53% of patients had a MPI-1 low risk, 34% had a MPI-2 moderate risk and 13% had a MPI-3 high risk (13%). Internal medicine inpatients had worse risk profile and higher MPI risk class than patients admitted to the cardiovascular department. Fifty-four patients (25%) experienced the primary end-point. In the multivariate logistic regression model MPI score [hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.23-2.71, P = 0.003], serum creatinine (HR 1.32, 95% CI 1.13-1.54, P < 0.001) and serum albumin (HR 0.43, 95% CI, P = 0.04) were independent predictors of 1-year mortality. The area under the receiver operating characteristic combining the MPI score with serum creatinine and albumin was 0.83 (CI 0.15-0.59, P < 0.001).

Conclusion: In ultra-octogenarian inpatients hospitalized for cardiovascular disease, MPI score independently predicts a poorer outcome. An integrated model including MPI, serum creatinine and albumine might aid the prognostic stratification of hospitalized elderly populations.