The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study
The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study
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DOI：
10.1093/ageing/afv167
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发表时间：
2016-01-01
期刊：
影响因子：
6.7
通讯作者：
Ferrucci, Luigi
中科院分区：
文献类型：
--
作者：
Pilotto, Alberto;Sancarlo, Daniele;Ferrucci, Luigi
背景资料：预测住院时间（LOS）可能有助于优化护理计划，以减少与住院相关的负面结果。目的：评估基于综合老年评估（CGA）的多维预后指数（MPI）是否可以预测住院老年患者的LOS。设计：前瞻性多中心队列研究。设置：20个老年科单位。参与者：连续入住老年病科的65岁及以上患者。测量：入院时，通过使用经验证的算法计算基于CGA的MPI，该算法包括关于日常生活的基础和工具活动、认知状态、营养状态、压疮风险、共病，毒品数量和同居状况。根据经验证的临界值，将受试者分为三组风险，即MPI-1低风险（千分之一货币符号0.33）、MPI-2中度死亡风险（0.34-0.66）和MPI-3重度死亡风险（千分之一日元0.67）。根据MPI分级划分的患者的年龄和性别校正的平均LOS为MPI-1 = 10.1（95% CI 8.6-11.8），MPI-2 = 12.47（95% CI 10.7-14.68）和MPI-3 = 13.41（95% CI 11.5-15.7）天（趋势P < 0.001）。MPI预测LOS的总体准确性良好（C-统计量0.74，95% CI 0.72-0.76）。此外，一个统计学上显着的趋势，LOS的手段，发现即使在患者分层，根据他们的国际疾病分类，第9次修订，临床修改（ICD-9-CM）的主要diagnosis.Conclusions：MPI是一个准确的预测LOS在老年患者住院的最常见的疾病。
Background: prediction of length of stay (LOS) may be useful to optimise care plans to reduce the negative outcomes related to hospitalisation.Objective: to evaluate whether the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), may predict LOS in hospitalised older patients.Design: prospective multicentre cohort study.Setting: twenty Geriatrics Units.Participants: patients aged 65 and older consecutively admitted to Geriatrics Units.Measurement: at admission, the CGA-based MPI was calculated by using a validated algorithm that included information on basal and instrumental activities of daily living, cognitive status, nutritional status, the risk of pressures sores, co-morbidity, number of drugs and co-habitation status. According to validated cut-offs, subjects were divided into three groups of risk, i.e. MPI-1 low risk (value a parts per thousand currency sign0.33), MPI-2 moderate risk (value 0.34-0.66) and MPI-3 severe risk of mortality (value a parts per thousand yen0.67).Results: two thousand and thirty-three patients were included; 1,159 were women (57.0%). Age- and sex-adjusted mean LOS in patients divided according to the MPI grade was MPI-1 = 10.1 (95% CI 8.6-11.8), MPI-2 = 12.47 (95% CI 10.7-14.68) and MPI-3 = 13.41 (95% CI 11.5-15.7) days (P for trend < 0.001). The overall accuracy of the MPI to predict LOS was good (C-statistic 0.74, 95% CI 0.72-0.76). Moreover, a statistically significant trend of LOS means was found even in patients stratified according to their International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) main diagnosis.Conclusions: the MPI is an accurate predictor of LOS in older patients hospitalised with the most frequent diseases.