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Multidimensional prognostic index predicts short- and long-term mortality and rehospitalizations in older patients with hip fracture

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Abstract

Background

Multidimensional Prognostic Index (MPI), calculated on cognitive, functional, nutritional, social, pharmacological and comorbidity domains, strongly correlates with mortality in older patients. Hip fractures are a major health problem and are associated with adverse outcomes in those affected by frailty.

Aim

We aimed at evaluating whether MPI is a predictor of mortality and rehospitalization in hip fracture older patients.

Methods

We investigated the associations of MPI with all-cause 3- and 6-month mortality and rehospitalization in 1259 older patients admitted for hip fracture surgical treatment and managed by an orthogeriatric team [age 85 years (65–109); male gender: 22%].

Results

Overall mortality was 11,4%, 17% and 23,5% at 3, 6 and 12 months from surgery (rehospitalizations: 15, 24,5 and 35,7%). MPI was associated (p < 0.001) with 3-, 6- and 12- month mortality and readmissions; Kaplan–Meier estimate for rehospitalization and survival according to MPI risk classes confirmed these results. In multiple regression analyses these associations were independent (p < 0.05) of mortality and rehospitalization-associated factors not included in the MPI, such as gender, age and post-surgical complications. Similar MPI predictive value was observed in patients undergoing endoprosthesis or other surgeries. ROC analysis confirmed that MPI was a predictor (p < 0.001) of both 3- and 6- month mortality and rehospitalization.

Conclusions

In hip fracture older patients, MPI is a strong predictor of 3-, 6- and 12- months mortality and rehospitalization, independently of surgical treatment and post-surgical complications. Therefore, MPI should be considered a valid pre-surgical tool to identify patients with higher clinical risk of adverse outcomes.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

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Funding

No funding was received to conduct this study. The authors have no relevant financial or non-financial interests to disclose.

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Authors and Affiliations

  1. Department of Medical Sciences, University of Trieste, Trieste, Italy

    Michela Zanetti, Michele Niero, Gianluca Gortan Cappellari, Rocco Barazzoni, Chiara Ratti & Luigi Murena

  2. Geriatric Clinic, Maggiore Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy

    Michela Zanetti & Paolo De Colle

  3. Orthopedic Clinic, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy

    Chiara Ratti & Luigi Murena

Authors
  1. Michela Zanetti
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  2. Paolo De Colle
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  3. Michele Niero
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  5. Rocco Barazzoni
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Contributions

MZ, PDC and RB contributed to the study conception and design. Material preparation, data collection and clinical activity on patients were performed by PDC. MZ and MN wrote and revised the article. RB examined the text, suggesting ideas for setting and focusing on the main aspects mentioned in the article. GGC performed the statistic analysis. CR and LM performed the surgeries. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michela Zanetti.

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The authors have no conflict of interest to declare.

Human and animal rights

The study was conducted according to the guidelines included in the Declaration of Helsinki involving human patients.

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Written informed consent for data access and use for research purposes was provided by either the patient or a nominated proxy.

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Zanetti, M., De Colle, P., Niero, M. et al. Multidimensional prognostic index predicts short- and long-term mortality and rehospitalizations in older patients with hip fracture. Aging Clin Exp Res 35, 1487–1495 (2023). https://doi.org/10.1007/s40520-023-02433-8

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  • DOI: https://doi.org/10.1007/s40520-023-02433-8

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