Multidimensional Prognostic Index in a Cognitive Impairment Outpatient Setting: Mortality and Hospitalizations. The Treviso Dementia (TREDEM) Study
Multidimensional Prognostic Index in a Cognitive Impairment Outpatient Setting: Mortality and Hospitalizations. The Treviso Dementia (TREDEM) Study
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DOI：
10.3233/jad-140516
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发表时间：
2014-01-01
影响因子：
4
通讯作者：
Pilotto, Alberto
中科院分区：
文献类型：
--
作者：
Gallucci, Maurizio;Battistella, Giuseppe;Pilotto, Alberto
背景：基于综合老年评估的多维预后指数（MPI）已被开发用于预测住院老年患者的死亡率。特雷维索痴呆（TREDEM）研究是一项观察性前瞻性队列研究，对2000年至2010年1月在意大利特雷维索认知障碍中心评估的1,364名门诊患者进行了评估。目的：在TREDEM门诊环境中使用MPI来评估MPI与评估日期后发生的急性病例死亡率和住院率的相关性。方法：自2008年MPI指数首次发布后，对2008年至2010年1月在中心评估的1364例门诊患者中的最后340例连续应用MPI。通过将队列与市政登记处、国家税务机关登记处和名义死亡原因登记处联系起来，对参与者的死亡率进行了核实。从意大利所有医院获得了评估日期后12个月内发生的急性病例住院的数据。在考虑年龄和性别等混杂因素的情况下，采用Cox回归方法研究MPI对死亡率和住院率的影响。结果：114名男性和226名女性，年龄52.1-99岁（平均80.4岁），MPI平均值为0.41。2013年2月15日，有100人死亡，急性病例的平均住院时间为0.3天，3.8天。对于MPI得分在0到1之间的患者，死亡概率增加了9倍以上（odds: 9.53 p = 0.0002），住院概率增加了6倍以上（odds: 6.50, p = 0.0079）。结论：MPI揭示了门诊认知障碍患者急性病例的死亡和住院风险。
Background: The Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment has been developed to predict mortality in hospitalized elderly patients. The Treviso Dementia (TREDEM) Study is an observational prospective cohort study of 1,364 outpatients evaluated at the Cognitive Impairment Center in Treviso, Italy from 2000 to January 2010.Objective: To use the MPI in the TREDEM outpatient setting to assess the correlation of MPI with mortality and hospitalizations for acute cases that occurred after the date of assessment.Methods: MPI was consecutively applied to the last 340 of 1,364 outpatients who were evaluated at the Center from 2008 to January 2010, after the first publication of MPI index in 2008. Participants' mortality was verified by linking the cohort with Registries of Municipalities, National Register of Revenue Authorities, and Nominal Register of Causes of Death. Data about hospitalizations for acute cases that occurred within 12 months after the date of assessment were obtained from all Italian hospitals. A Cox regression method was used to investigate the effect of MPI upon mortality and hospitalizations, also considering confounder factors such as age and gender.Results: 114 men and 226 women, aged 52.1-99 years (mean age 80.4 years), were studied and had an MPI mean of 0.41. On 15 February 2013, 100 were deceased, and average hospitalizations for acute cases were 0.3, days 3.8. For MPI scores between 0 and 1, the increase in the probability of death was more than nine times (odds: 9.53 p = 0.0002) and of hospitalization was more than six times (odds: 6.50, p = 0.0079).Conclusion: MPI discloses the risk of death and of hospitalizations for acute cases in outpatients affected by cognitive impairment.