Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Sep;23(9):1608.e1-1608.e8.
doi: 10.1016/j.jamda.2022.06.023. Epub 2022 Jul 1.

Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An Observational, Prospective, Multicenter Study

Alberto Pilotto  1 , Eva Topinkova  2 , Helena Michalkova  2 , Maria Cristina Polidori  3 , Alberto Cella  4 , Alfonso Cruz-Jentoft  5 , Christine A F von Arnim  6 , Margherita Azzini  7 , Heidi Gruner  8 , Alberto Castagna  9 , Giovanni Cenderello  10 , Romina Custureri  4 , Carlo Custodero  11 , Tania Zieschang  12 , Alessandro Padovani  13 , Elisabet Sanchez-Garcia  5 , Nicola Veronese  14 ; MPI-COVID-19 Study Group Investigators
Collaborators, Affiliations
Observational Study

Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An Observational, Prospective, Multicenter Study

Alberto Pilotto et al. J Am Med Dir Assoc. 2022 Sep.

Abstract

Objective: Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation.

Design: Longitudinal, multicenter study.

Settings and participants: 502 older people hospitalized for COVID-19 in 10 European hospitals.

Methods: MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI).

Results: Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes.

Conclusions and implications: MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.

Keywords: COVID-19; Comprehensive Geriatric Assessment; Multidimensional Prognostic Index; mechanical ventilation; mortality; noninvasive ventilation; prognosis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Receiver operating characteristic curve using different combinations of age, sex, Pao2/Fio2, and MPI as exposure and the incidence of rehospitalization/mortality during follow-up.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Mueller A.L., McNamara M.S., Sinclair D.A. Why does COVID-19 disproportionately affect older people? Aging (Albany NY) 2020;12:9959. - PMC - PubMed
    1. Polidori M.C., Maggi S., Mattace-Raso F., Pilotto A. The unavoidable costs of frailty: a geriatric perspective in the time of COVID-19. Geriatric Care. 2020:6.
    1. Lithander F.E., Neumann S., Tenison E., et al. COVID-19 in older people: a rapid clinical review. Age Ageing. 2020;49:501–515. - PMC - PubMed
    1. James A., Verdonk F., Bougle A., Constantin J.M. Non-invasive ventilation for acute respiratory failure (in COVID-19 patients): The non-ending story? Anaesth Crit Care Pain Med. 2020;39:549. - PMC - PubMed
    1. Montero-Odasso M., Hogan D.B., Lam R., et al. Age alone is not adequate to determine health-care resource allocation during the COVID-19 pandemic. Can Geriatr J. 2020;23:152–154. - PMC - PubMed

Publication types