Rizza Stefano, Morabito Pasquale, De Meo Livia, Farcomeni Alessio, Testorio Giulia, Cardellini Marina, Ballanti Marta, Davato Francesca, Pecchioli Chiara, Di Cola Giovanni, Mavilio Maria, Federici Massimo
1Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
2Department of Economics and Finance, University of Rome Tor Vergata, Rome, Italy.
Aging Dis. 2021 Apr 1;12(2):353-359. doi: 10.14336/AD.2020.0713. eCollection 2021 Apr.
The multidimensional prognostic index (MPI) is a sensitive and specific prognosis estimation tool that accurately predicts all-cause mortality in frail older patients. It has been validated to assess the risk of 1-month to 2-year mortality in frail older patients during hospitalization and after hospital discharge. However, whether the MPI is a valid prognostic tool for follow-up periods of different lengths remains to be validated. To this end, we followed up 80 hospitalized patients (female=37, male 43) at least 75 years of age (mean age=82.6±4.4, range=75-94 years) to assess the 3-month all-cause mortality (mean follow-up=61.0 ± 31.7 months [range 4-90 days]). Accordingly, patients were subdivided into low (MPI-1, score 0-0.33), moderate (MPI-2, score 0.34-0.66) and high (MPI-3, score 0.67-1) mortality risk classes. Moreover, baseline biochemical, inflammatory and metabolic parameters, as well as anamnestic and clinical characteristics, were obtained. Although the MPI-3 score was significantly associated with 3-month all-cause mortality in univariate analysis (HR=5.79, 95%CI=1.77-18.92, p=0.004), a multivariate model indicated that only low albumin (HR=0.33, 95%CI=0.16-0.68, p=0.003) and high IL6 (HR=1.01, 95%CI=1.00-1.02, p=0.010) levels were significantly associated with 3-month all-cause mortality. In conclusion, we suggest that measurement of IL6 as well as albumin, rather than the MPI score, may help in providing tailored therapeutic interventions to decrease short term mortality in older hospitalized individuals.
多维预后指数（MPI）是一种敏感且特异的预后评估工具，可准确预测体弱老年患者的全因死亡率。它已被验证可用于评估体弱老年患者住院期间及出院后1个月至2年的死亡风险。然而，MPI对于不同时长随访期是否为有效的预后工具仍有待验证。为此，我们对80例至少75岁（平均年龄 = 82.6±4.4岁，范围 = 75 - 94岁）的住院患者（女性37例，男性43例）进行随访，以评估3个月的全因死亡率（平均随访时间 = 61.0 ± 31.7个月[范围4 - 90天]）。据此，将患者分为低（MPI - 1，评分0 - 0.33）、中（MPI - 2，评分0.34 - 0.66）和高（MPI - 3，评分0.67 - 1）死亡风险类别。此外，还获取了基线生化、炎症和代谢参数以及既往病史和临床特征。虽然在单因素分析中MPI - 3评分与3个月全因死亡率显著相关（HR = 5.79，95%CI = 1.77 - 18.92，p = 0.004），但多变量模型表明，只有低白蛋白水平（HR = 0.33，95%CI = 0.16 - 0.68，p = 0.003）和高IL6水平（HR = 1.01，95%CI = 1.00 - 1.02，p = 0.010）与3个月全因死亡率显著相关。总之，我们建议检测IL6以及白蛋白水平，而非MPI评分，可能有助于提供针对性的治疗干预措施，以降低老年住院患者的短期死亡率。
