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
- Author
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Alberto Pilotto, Eva Topinkova, Helena Michalkova, Maria Cristina Polidori, Alberto Cella, Alfonso Cruz-Jentoft, Christine A.F. von Arnim, Margherita Azzini, Heidi Gruner, Alberto Castagna, Giovanni Cenderello, Romina Custureri, Carlo Custodero, Tania Zieschang, Alessandro Padovani, Elisabet Sanchez-Garcia, Nicola Veronese, Mario Barbagallo, Simone Dini, Naima Madlen Diesner, Marilia Fernandes, Federica Gandolfo, Sara Garaboldi, Clarissa Musacchio, Andrea Pilotto, Lena Pickert, Silvia Podestà, Giovanni Ruotolo, Katiuscia Sciolè, Julia Schlotmann, Pilotto, Alberto, Topinkova, Eva, Michalkova, Helena, Polidori, Maria Cristina, Cella, Alberto, Cruz-Jentoft, Alfonso, von Arnim, Christine A F, Azzini, Margherita, Gruner, Heidi, Castagna, Alberto, Cenderello, Giovanni, Custureri, Romina, Custodero, Carlo, Zieschang, Tania, Padovani, Alessandro, Sanchez-Garcia, Elisabet, and Veronese, Nicola
- Subjects
Aged, 80 and over ,Health Policy ,COVID-19 ,Humans ,Prospective Studies ,General Medicine ,COVID-19, Comprehensive Geriatric Assessment, Multidimensional Prognostic Index, mechanical ventilation, mortality,noninvasive ventilation, prognosis ,Geriatrics and Gerontology ,Prognosis ,Geriatric Assessment ,Respiration, Artificial ,General Nursing ,Aged - 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. (C) 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
- Published
- 2022