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Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An Observational, Prospective, Multicenter Study

A. Pilotto, E. Topinkova, H. Michalkova, MC. Polidori, A. Cella, A. Cruz-Jentoft, CAF. von Arnim, M. Azzini, H. Gruner, A. Castagna, G. Cenderello, R. Custureri, C. Custodero, T. Zieschang, A. Padovani, E. Sanchez-Garcia, N. Veronese,...

. 2022 ; 23 (9) : 1608.e1-1608.e8. [pub] 20220701

Language English Country United States

Document type Journal Article, Multicenter Study, Observational Study

Persistent link   https://www.medvik.cz/link/bmc22024594

OBJECTIVE: Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. DESIGN: Longitudinal, multicenter study. SETTINGS AND PARTICIPANTS: 502 older people hospitalized for COVID-19 in 10 European hospitals. METHODS: MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). RESULTS: Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. CONCLUSIONS AND IMPLICATIONS: MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.

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$a Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An Observational, Prospective, Multicenter Study / $c A. Pilotto, E. Topinkova, H. Michalkova, MC. Polidori, A. Cella, A. Cruz-Jentoft, CAF. von Arnim, M. Azzini, H. Gruner, A. Castagna, G. Cenderello, R. Custureri, C. Custodero, T. Zieschang, A. Padovani, E. Sanchez-Garcia, N. Veronese, MPI-COVID-19 Study Group Investigators
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$a OBJECTIVE: Data on prognostic tools for indicating mechanical ventilation in older people with COVID-19 are still limited. The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from mechanical ventilation. DESIGN: Longitudinal, multicenter study. SETTINGS AND PARTICIPANTS: 502 older people hospitalized for COVID-19 in 10 European hospitals. METHODS: MPI was calculated using 8 different domains typical of the CGA. A propensity score, Cox's regression analysis was used for assessing the impact of mechanical ventilation on rehospitalization/mortality for 90 days' follow-up, stratified by MPI = 0.50. The accuracy of MPI in predicting negative outcomes (ie, rehospitalization/mortality) was assessed using the area under the curve (AUC), and the discrimination with several indexes like the Net Reclassification Improvement (NRI) and the Integrated Discrimination Improvement (IDI). RESULTS: Among 502 older people hospitalized for COVID-19 (mean age: 80 years), 152 were treated with mechanical ventilation. In the propensity score analysis, during the 90-day follow-up period, there were 44 rehospitalizations and 95 deaths. Mechanical ventilation in patients with MPI values ≥ 0.50, indicating frailer participants, was associated with a higher risk of rehospitalization/mortality (hazard ratio 1.56, 95% CI 1.09-2.23), whereas in participants with MPI values < 0.50 this association was not significant. The accuracy of the model including age, sex, respiratory parameters, and MPI was good (AUC = 0.783) as confirmed by an NRI of 0.2756 (P < .001) and an IDI of 0.1858 (P < .001), suggesting a good discrimination of the model in predicting negative outcomes. CONCLUSIONS AND IMPLICATIONS: MPI could be useful for better individualizing older people hospitalized by COVID-19 who could benefit from mechanical ventilation.
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$a Topinkova, Eva $u Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
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$a Michalkova, Helena $u Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic
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$a Polidori, Maria Cristina $u Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine, University of Cologne, Cologne, Germany
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$a Cella, Alberto $u Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
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$a Cruz-Jentoft, Alfonso $u Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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$a von Arnim, Christine A F $u Division of Geriatrics, University Medical Center Goettingen, Goettingen, Germany
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$a Azzini, Margherita $u Geriatrics Unit, "Mater Salutis" Hospital, Legnago ULSS 9 Scaligera, Verona, Italy
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$a Gruner, Heidi $u Serviço de Medicina Interna, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central / Universidade Nova de Lisboa Lisbon, Portugal
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$a Castagna, Alberto $u Geriatrics Unit, "Pugliese Ciaccio" Hospital, Catanzaro, Italy
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$a Cenderello, Giovanni $u Infectious Disease Unit, Sanremo Hospital, ASL 1 Imperiese, Sanremo, Italy
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$a Custureri, Romina $u Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy
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$a Custodero, Carlo $u Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
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$a Zieschang, Tania $u Klinikum Oldenburg AöR, Oldenburg University, Oldenburg, Germany
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$a Padovani, Alessandro $u Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
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$a Sanchez-Garcia, Elisabet $u Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
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