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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

  • JNHA: Nutrition
  • Published:
The journal of nutrition, health & aging

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.

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References

  1. Kulminski AM, Ukraintseva SV, Kulminskaya IV, Arbeev KG, Land K, Yashin AI. Cumulative Deficits Better Characterize Susceptibility to Death in Elderly People than Phenotypic Frailty: Lessons from the Cardiovascular Health Study. J Am Geriatr Soc. 2008; 56: 898–903.

    Article  PubMed  Google Scholar 

  2. Rockwood K, Mitnitski A, Song X, Steen B, Skoog I. Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc. 2006;54:975–979.

    Article  PubMed  Google Scholar 

  3. Pilotto A, Ferrucci L, Franceschi M, D’Ambrosio LP, Scarcelli C, Cascavilla L, Paris F, Placentino G, Seripa D, Dallapiccola B, Leandro G. Development and validation of a Multidimensional Prognostic Index for 1-Year Mortality from the Comprehensive Geriatric Assessment in Hospitalized Older Patients. Rejuvenation Res. 2008; 11:151–161.

    Article  PubMed  Google Scholar 

  4. Pilotto A, Ferrucci L, Scarcelli C, Niro V, Di Mario F, Seripa D, Andriulli A, Leandro G, Franceschi M. Usefulness of the comprehensive geriatric assessment in older patient with upper gastorintestinal bleeding: a two year follow-up study. Dig Dis. 2007; 25: 124–128.

    Article  PubMed  Google Scholar 

  5. Pilotto A, Addante F, Ferrucci L, Leandro G, D’Onofrio G, Corritore M, Niro V, Scarcelli C, Dallapiccola B, Franceschi M. The Multidimensional Prognostic Index predicts short- and long-term mortality in hospitalized geriatric patients with pneumonia. J Gerontol A Biol Sci Med Sci. 2009; 64: 880–887.

    Article  PubMed  Google Scholar 

  6. Pilotto A, Addante F, Franceschi L et al. A Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure. Circulation Heart Fail. 2010; 3: 14–20.

    Article  Google Scholar 

  7. Pilotto A, Addante F, D’Onofrio G et al. The Comprehensive Geriatric Assessment and the multidimensional approach. A new look at the older patient with gastroenterological disorders. Best Pract Res Clin Gastroenterol. 2009;23: 829–837.

    Article  PubMed  Google Scholar 

  8. Pilotto A, Sancarlo D, Panza, F, Paris F, D’Onofrio G, Cascavilla L et al. The Multidimensional Prognostic Index (MPI) Based on a Comprehensive Geriatric Assessment Predicts Short- and Long-term Mortality in Hospitalized Older Patients with Dementia. J Alzheimers Dis. 2009; 18: 191–199.

    PubMed  Google Scholar 

  9. Guigoz Y, Vellas B. The Mini Nutritional Assessment (MNA) for grading the malnutrition states of elderly patients: presentation of the MNA, history and validation. Nestle NutrWorkshop Ser Clin Performe Programme. 1999; 1: 3–11.

    Article  CAS  Google Scholar 

  10. Rubenstein LZ, Harker JO, Salva A. Screening for undernutrition in geriatric practice: developing the shor-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001; 56: M366–M372.

    PubMed  CAS  Google Scholar 

  11. Vellas B, Villars H, Abellan G et al. Overview of the MNA—Its history and challenges. J Nutr Health Aging. 2006; 10:456–463.

    PubMed  CAS  Google Scholar 

  12. Katz S, Downs TD, Cash HR, Grotz RC. Progress in the development of an index of ADL. Gerontologist. 1970; 10: 20–30.

    PubMed  CAS  Google Scholar 

  13. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969; 9: 179–186.

    PubMed  CAS  Google Scholar 

  14. Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975; 23: 433–441.

    PubMed  CAS  Google Scholar 

  15. Linn B, Linn M, Gurel L. Cumulative Illness Rating Scale. J Am Geriatr Soc. 1968; 16: 622–626.

    PubMed  CAS  Google Scholar 

  16. Bliss MR, McLaren R, Exton-Smith AN. Mattresses for preventing pressure sores in geriatric patients. Mon Bull Minis Health Public Health Lab Serv. 1966; 25: 238–268.

    CAS  Google Scholar 

  17. Kaiser MJ, Bauer JM, Ramsch C et al. Validation of the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009; 13: 782–788.

    Article  PubMed  CAS  Google Scholar 

  18. Obuchowski NA, McClish DK. Sample size determination for diagnostic accuracy studies involving binormal ROC curve indices. Statistics Medicine 1997;16:1529–1542.

    Article  CAS  Google Scholar 

  19. Reuben DB, Greendale GA, Harrison GG. Nutrition screening in older persons. J Am Geriatr Soc. 1995; 43: 415–425.

    PubMed  CAS  Google Scholar 

  20. Rudman D, Feller AG. Protein-calorie undernutrition in the nursing home. J Am Geriatr Soc. 1995; 37:173–183.

    Google Scholar 

  21. Guigoz Y. The Mini Nutritional Assessment (MNA). Review of the literature — what does it tell us? J Nutr Health Aging 2006; 10: 466–487.

    PubMed  CAS  Google Scholar 

  22. Thomas DR, Zdrowsski CD, Wilson MM et al., Malnutrition in subacute care. Am J Clin Nutr. 2002; 75:308–313.

    PubMed  CAS  Google Scholar 

  23. Olde Rikkert MG, Rigaud AS. Malnutrition research: high time to change the menu. Age Aging. 2003; 32: 241–243.

    Article  Google Scholar 

  24. Kagansky N, Berner Y, Koren-Morag N et al. Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. Am J Clin Nutr. 2005; 82: 784–791.

    PubMed  CAS  Google Scholar 

  25. Salva A, Corman B, Andrieu S et al, Minimum Data Set for Nutritional Interventions in the Elderly IAG/IANA task force consensus. J Nutr Health Aging. 2004; 8: 202–206.

    PubMed  CAS  Google Scholar 

  26. Carey EC, Covinsky KE, Lui LY et al. Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc. 2008; 56: 68–75.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Geriatrics Unit & Gerontology-Geriatric Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy

    D. Sancarlo, G. D’Onofrio, M. Franceschi, C. Scarcelli, V. Niro, F. Addante & Alberto Pilotto

  2. Unit of Biostatistics, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy

    M. Copetti

  3. National Institute on Aging, Longitudinal Studies Section, Harbor Hospital Center, Baltimore, MD, USA

    L. Ferrucci

  4. Division of Nutrition and Aging, Istituto Superiore di Sanità, Rome, Italy

    L. Fontana

  5. Division of Geriatrics and Nutritional Science, Washington University in St. Louis, St. Louis, MO, USA

    L. Fontana

  6. Geriatric Unit & Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, San Giovanni Rotondo (FG), I-71013, Italy

    Alberto Pilotto

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  1. D. Sancarlo
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  2. G. D’Onofrio
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  3. M. Franceschi
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  4. C. Scarcelli
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  5. V. Niro
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  6. F. Addante
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  8. L. Ferrucci
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  9. L. Fontana
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  10. Alberto Pilotto
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Correspondence to Alberto Pilotto.

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Sancarlo, D., D’Onofrio, G., Franceschi, M. et al. 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. J Nutr Health Aging 15, 169–173 (2011). https://doi.org/10.1007/s12603-010-0293-5

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  • DOI: https://doi.org/10.1007/s12603-010-0293-5

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