Cardiovascular Department, Azienda Sanitaria-Universitaria Integrata Trieste 'ASUITS', University of Trieste, Trieste.
Department of Medicine, University Hospital 'Santa Maria della Misericordia', Udine.
J Cardiovasc Med (Hagerstown). 2018 Oct;19(10):536-545. doi: 10.2459/JCM.0000000000000699.
The multidimensional prognostic index (MPI) is a validated tool for prognostic stratification in acute and chronic setting of geriatric patients. However, only few data are available on patients with cardiovascular diseases.
To evaluate the potential role of MPI as predictor of 1-year and long-term outcome in ultra-octogenarians patients hospitalized for cardiovascular diseases.
We conducted a prospective study on 216 patients (mean age 85 ± 4 years) hospitalized for cardiovascular disease enrolled from September 2011 to February 2014 in both Cardiology and Internal Medicine Departments. The mean follow-up was 33 ± 7 months. The primary end-point was 1-year all-cause mortality. In addition, 3-year all-cause mortality was also assessed in the overall cohort and outcome prediction was then evaluated separately in patients with a primary diagnosis of heart failure and acute coronary syndrome. At admission, 53% of patients had a MPI-1 low risk, 34% had a MPI-2 moderate risk and 13% had a MPI-3 high risk (13%). Internal medicine inpatients had worse risk profile and higher MPI risk class than patients admitted to the cardiovascular department. Fifty-four patients (25%) experienced the primary end-point. In the multivariate logistic regression model MPI score [hazard ratio (HR) 1.83, 95% confidence interval (CI) 1.23-2.71, P = 0.003], serum creatinine (HR 1.32, 95% CI 1.13-1.54, P < 0.001) and serum albumin (HR 0.43, 95% CI, P = 0.04) were independent predictors of 1-year mortality. The area under the receiver operating characteristic combining the MPI score with serum creatinine and albumin was 0.83 (CI 0.15-0.59, P < 0.001).
In ultra-octogenarian inpatients hospitalized for cardiovascular disease, MPI score independently predicts a poorer outcome. An integrated model including MPI, serum creatinine and albumine might aid the prognostic stratification of hospitalized elderly populations.
多维预后指数（MPI）是一种经过验证的老年患者急性和慢性疾病预后分层工具。然而，只有很少的数据可用于患有心血管疾病的患者。
评估 MPI 作为预测因子在因心血管疾病住院的超高龄患者 1 年和长期预后中的潜在作用。
我们对 2011 年 9 月至 2014 年 2 月期间在心脏病学和内科部门住院的 216 名（平均年龄 85±4 岁）因心血管疾病住院的患者进行了前瞻性研究。平均随访时间为 33±7 个月。主要终点为 1 年全因死亡率。此外，还评估了整个队列的 3 年全因死亡率，并分别在心衰和急性冠脉综合征的患者中评估了预后预测。入院时，53%的患者 MPI-1 低危，34%的患者 MPI-2 中危，13%的患者 MPI-3 高危（13%）。内科住院患者的风险状况和 MPI 风险等级均较心脏病学部门患者差。54 名患者（25%）发生了主要终点事件。多变量逻辑回归模型显示，MPI 评分[危险比（HR）1.83，95%置信区间（CI）1.23-2.71，P=0.003]、血清肌酐（HR 1.32，95%CI 1.13-1.54，P<0.001）和血清白蛋白（HR 0.43，95%CI，P=0.04）是 1 年死亡率的独立预测因素。将 MPI 评分与血清肌酐和白蛋白相结合的接受者操作特征曲线下面积为 0.83（CI 0.15-0.59，P<0.001）。
在因心血管疾病住院的超高龄患者中，MPI 评分独立预测预后不良。包含 MPI、血清肌酐和白蛋白的综合模型可能有助于对住院老年人群进行预后分层。
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