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Mortality and readmission risk can be predicted by the record-based Multidimensional Prognostic Index: a cohort study of medical inpatients older than 75 years

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European Geriatric Medicine Aims and scope Submit manuscript

An Editorial to this article was published on 23 February 2021

Key summary points

AbstractSection Aim

The aim was to examine the predictive value of the record-based MPI in terms of mortality, readmission and LOS.

AbstractSection Findings

The record-based MPI assessed at discharge predicted mortality and readmission risk in medical inpatients aged ≥ 75 years. Higher MPI risk scores were also associated with longer hospital stay, higher age and female sex.

AbstractSection Message

The record-based MPI is valuable in predicting mortality and other frailty-related, negative health outcomes in older medical inpatients, and the method is applicable as an alternative to bedside MPI in older hospitalized medical patients.

Abstract

Purpose

To examine the predictive value of the record-based Multidimensional Prognostic Index (MPI) on mortality, readmission and length of hospital stay (LOS) among older medical inpatients.

Methods

A cohort of medical inpatients aged ≥ 75 years was rated using the record-based MPI to assess frailty retrospectively. 90-day and 1-year mortality hazard ratios (HRs) were calculated in a sex- and age-adjusted Cox proportional hazards model. 30-day readmission relative risk (RR) estimates were calculated in a binary regression model with mortality as a competing risk. Discrimination was expressed by the area under the receiver operating characteristic (ROC) curve. Median LOS was calculated using the non-parametric Kruskal–Wallis one-way ANOVA.

Results

In total, 1190 patients with a median age of 83 years were included. 50% were male. 335 patients (28%) were categorized as non-frail (MPI score 0.0–0.33), 522 (44%) moderately frail (MPI score 0.34–0.66) and 333 (28%) severely frail (MPI score 0.67–1.0). 90-day mortality HR was 7.4 (95% confidence interval (CI) 2.9–18.6, p < 0.001) for the moderately frail and 18.5 (95% CI 7.5–46.1, p < 0.001) for the severely frail compared with the non-frail. ROC area was 0.76 (95% CI 0.72–0.80). Similarly, 1-year mortality HR was 3.3 (95% CI 2.2–5.0, p < 0.001) for the moderately frail and 7.1 (95% CI 4.7–10.6, p < 0.001) for the severely frail. 30-day readmission RR was 2.1 (95% CI 1.5–2.9, p < 0.001) for the moderately frail and 1.8 (95% CI 1.3–2.6, p = 0.001) for the severely frail. LOS was significantly longer with increasing MPI score (p < 0.001).

Conclusion

The record-based MPI assessed at discharge predicts dose-dependent post-discharge mortality and readmission risk and is associated with LOS in older medical inpatients.

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Availability of data and material

Anonymized data are available on request. To maintain confidentiality, the medical record material is not available. The study protocol (in Danish) is available on request.

Code availability

Stata code is available on request.

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Acknowledgements

We would like to thank the multidisciplinary staff in the MD, ED and the four municipalities for their meticulous medical record-keeping and intersectoral cooperation.

Funding

This work was part of a PhD project supported by A.P. Møller Fonden (DKK 45,000), Helsefonden (DKK 350,000) and the Health Research Fund of Central Denmark Region (DKK 100,000).

Author information

Authors and Affiliations

  1. Department of Geriatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Troels Kjærskov Hansen, Else Marie Damsgaard & Merete Gregersen

  2. Medical Department, Randers Regional Hospital, Randers, Denmark

    Troels Kjærskov Hansen, Seham Shahla, Sofie Ran Lindhardt Bossen & Jens Meldgaard Bruun

  3. Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark

    Else Marie Damsgaard, Jens Meldgaard Bruun & Merete Gregersen

  4. Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus N, Denmark

    Jens Meldgaard Bruun

Authors
  1. Troels Kjærskov Hansen
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  2. Seham Shahla
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Contributions

The authors fulfil the ICMJE criteria for authorship. Study concept and design: Troels Kjærskov. Hansen (TKH), Seham Shahla (SS), Else Marie Damsgaard (EMD), Sofie Ran Lindhardt Bossen (SRLB), Jens Meldgaard Bruun (JMB), Merete Gregersen (MG); Acquisition of data: TKH, SRLB; Analysis and interpretation of data: TKH, SS, EMD, SRLB, JMB, MG.

Corresponding author

Correspondence to Troels Kjærskov Hansen.

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Conflict of interest

The authors had no conflicts of interest.

Ethics approval

The project was approved as a quality development project by the Regional Research Ethics Committee (197/2017) and the local hospital administration; hence, no further approval or consent was needed.

Informed consent

No patient received less than usual care, any extra treatment, examination or exposure because of the study.

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Appendix

Appendix

See Fig. 4.

Fig. 4
figure 4

Box-and-whiskers plots showing median LOS as function of MPI risk grade 1, 2 and 3 (left) and the aggregated MPI score (right). The overall median LOS was 3 days. LOS was not significantly affected by sex (p = 0.73). The Kruskal–Wallis hypothesis test showed significantly longer LOS in older patients (p = 0.037), with increasing MPI risk grades (p < 0.001), also when the analysis was based on the MPI score (p < 0.001). MPI Multidimensional Prognostic Index, LOS length of hospital stays. The plots show the mean values (line in box), interquartile ranges (box), and upper and lower values within 1.5 times the interquartile ranges (whiskers), as well as outliers beyond the whiskers (circles). Four outliers had a LOS > 30 days (located outside the plotted area); their LOS were 95 days (MPI = 2); 41 days (MPI = 2); 37 days (MPI = 3) and 34 days (MPI = 3). Only three patients had a MPI score = 1

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Hansen, T.K., Shahla, S., Damsgaard, E.M. et al. Mortality and readmission risk can be predicted by the record-based Multidimensional Prognostic Index: a cohort study of medical inpatients older than 75 years. Eur Geriatr Med 12, 253–261 (2021). https://doi.org/10.1007/s41999-021-00453-z

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