The journal of nutrition, health & aging

, Volume 15, Issue 3, pp 169–173

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
  • Alberto Pilotto
JNHA: Nutrition

DOI: 10.1007/s12603-010-0293-5

Cite this article as:
Sancarlo, D., D’Onofrio, G., Franceschi, M. et al. J Nutr Health Aging (2011) 15: 169. doi:10.1007/s12603-010-0293-5

Abstract

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.

Key words

Multidimensional Prognostic Index (MPI) Mini Nutritional Assessment Short Form (MNASF) mortality prognosis Comprehensive Geriatric Assessment (CGA) survival 

Copyright information

© Serdi and Springer Verlag France 2011

Authors and Affiliations

  • D. Sancarlo
    • 1
  • G. D’Onofrio
    • 1
  • M. Franceschi
    • 1
  • C. Scarcelli
    • 1
  • V. Niro
    • 1
  • F. Addante
    • 1
  • M. Copetti
    • 2
  • L. Ferrucci
    • 3
  • L. Fontana
    • 4
    • 5
  • Alberto Pilotto
    • 1
    • 6
  1. 1.Geriatrics Unit & Gerontology-Geriatric Research Laboratory, Department of Medical SciencesIRCCS Casa Sollievo della SofferenzaSan Giovanni RotondoItaly
  2. 2.Unit of BiostatisticsIRCCS “Casa Sollievo della Sofferenza”San Giovanni RotondoItaly
  3. 3.National Institute on Aging, Longitudinal Studies SectionHarbor Hospital CenterBaltimoreUSA
  4. 4.Division of Nutrition and AgingIstituto Superiore di SanitàRomeItaly
  5. 5.Division of Geriatrics and Nutritional ScienceWashington University in St. LouisSt. LouisUSA
  6. 6.Geriatric Unit & Gerontology-Geriatrics Research Laboratory, Department of Medical SciencesIRCCS Casa Sollievo della SofferenzaSan Giovanni Rotondo (FG)Italy