Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia, Italy.
J Neurol. 2012 Apr;259(4):670-8. doi: 10.1007/s00415-011-6241-4. Epub 2011 Sep 23.
A multidimensional impairment may influence the clinical outcome of acute diseases in older patients. The aim of the current study was to evaluate whether a Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment (CGA) predicts short- and long-term all-cause mortality in older patients hospitalized for transient ischemic attack (TIA). In this prospective study with 1-year follow-up, 654 patients aged 65 and older with a diagnosis of TIA according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM 435.x) were enrolled. A standardized CGA that included information on functional (activities of daily living, ADL, and Instrumental ADL), cognitive status (Short Portable Mental Status Questionnaire), nutrition (Mini Nutritional Assessment), risk of pressure sores (Exton-Smith Scale), comorbidities (Cumulative Illness Rating Scale), medications and co-habitation status was used to calculate the MPI for mortality using a previously validated algorithm. Higher MPI values were significantly associated with higher 1-month all-cause mortality (incidence rates: MPI-1 low risk = 0.32%, MPI-2 moderate risk = 5.36%, MPI-3 high risk = 10.42%; p < 0.001), 6-month all-cause mortality (MPI-1 = 1.95%, MPI-2 = 9.77%, MPI-3 = 27.22%; p < 0.001) and 12-month all-cause mortality (MPI-1 = 5.19%, MPI-2 = 16.47%, MPI-3 = 44.32%; p < 0.001). Age- and gender-adjusted Cox regression analyses demonstrated that MPI was a significant predictor of all-cause mortality. MPI showed a significant high discriminatory power with an area under the receiver operating characteristics (ROC) curve of 0.819, 95% CI = 0.749-0.888 for 1-month mortality, 0.799, 95% CI = 0.738-0.861 for 6-month mortality and 0.770, 95% CI = 0.716-0.824 for 12-month mortality. The MPI, calculated from information collected in a standardized CGA, appeared to be effective in estimating short- and long-term all-cause mortality in older patients hospitalized for TIA.
多维障碍可能会影响老年患者急性疾病的临床转归。本研究旨在评估基于全面老年评估（CGA）的多维预后指数（MPI）是否可以预测短暂性脑缺血发作（TIA）住院老年患者的短期和长期全因死亡率。在这项前瞻性研究中，对 1 年的随访，纳入了 654 名年龄在 65 岁及以上、根据国际疾病分类、第九修订版、临床修正版（ICD-9-CM 435.x）诊断为 TIA 的患者。采用标准化的 CGA，包括功能（日常生活活动、工具性日常生活活动）、认知状态（简易精神状态问卷）、营养状况（微型营养评估）、压疮风险（埃克顿-史密斯量表）、合并症（累积疾病评分量表）、药物和共同居住状况的信息，使用之前验证的算法计算死亡率的 MPI。较高的 MPI 值与较高的 1 个月全因死亡率（发生率：MPI-1 低危=0.32%，MPI-2 中危=5.36%，MPI-3 高危=10.42%；p<0.001）、6 个月全因死亡率（MPI-1=1.95%，MPI-2=9.77%，MPI-3=27.22%；p<0.001）和 12 个月全因死亡率（MPI-1=5.19%，MPI-2=16.47%，MPI-3=44.32%；p<0.001）显著相关。年龄和性别调整的 Cox 回归分析表明，MPI 是全因死亡率的显著预测因素。MPI 的曲线下面积（ROC）为 0.819，95%CI=0.749-0.888，对 1 个月死亡率有显著的高判别能力，95%CI=0.799，0.738-0.861，6 个月死亡率为 0.799，95%CI=0.738-0.861，12 个月死亡率为 0.770，95%CI=0.716-0.824。MPI 是根据标准化 CGA 收集的信息计算出来的，它似乎可以有效地评估 TIA 住院老年患者的短期和长期全因死亡率。
