Universität zu Köln

Pilotto, Alberto, Topinkova, Eva ORCID: 0000-0002-6786-4116, Michalkova, Helena, Polidori, Maria Cristina, Cella, Alberto, Cruz-Jentoft, Alfonso, von Arnim, Christine A. F., Azzini, Margherita, Gruner, Heidi, Castagna, Alberto, Cenderello, Giovanni, Custureri, Romina, Custodero, Carlo ORCID: 0000-0003-1549-6451, Zieschang, Tania, Padovani, Alessandro ORCID: 0000-0002-0119-3639, Sanchez-Garcia, Elisabet and Veronese, Nicola ORCID: 0000-0002-9328-289X (2022). 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. J. Am. Med. Dir. Assoc., 23 (9). NEW YORK: ELSEVIER SCIENCE INC. ISSN 1538-9375

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Abstract

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. (C) 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Pilotto, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED Topinkova, Eva UNSPECIFIED orcid.org/0000-0002-6786-4116 UNSPECIFIED Michalkova, Helena UNSPECIFIED UNSPECIFIED UNSPECIFIED Polidori, Maria Cristina UNSPECIFIED UNSPECIFIED UNSPECIFIED Cella, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED Cruz-Jentoft, Alfonso UNSPECIFIED UNSPECIFIED UNSPECIFIED von Arnim, Christine A. F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Azzini, Margherita UNSPECIFIED UNSPECIFIED UNSPECIFIED Gruner, Heidi UNSPECIFIED UNSPECIFIED UNSPECIFIED Castagna, Alberto UNSPECIFIED UNSPECIFIED UNSPECIFIED Cenderello, Giovanni UNSPECIFIED UNSPECIFIED UNSPECIFIED Custureri, Romina UNSPECIFIED UNSPECIFIED UNSPECIFIED Custodero, Carlo UNSPECIFIED orcid.org/0000-0003-1549-6451 UNSPECIFIED Zieschang, Tania UNSPECIFIED UNSPECIFIED UNSPECIFIED Padovani, Alessandro UNSPECIFIED orcid.org/0000-0002-0119-3639 UNSPECIFIED Sanchez-Garcia, Elisabet UNSPECIFIED UNSPECIFIED UNSPECIFIED Veronese, Nicola UNSPECIFIED orcid.org/0000-0002-9328-289X UNSPECIFIED
URN:	urn:nbn:de:hbz:38-693682
DOI:	10.1016/j.jamda.2022.06.023
Journal or Publication Title:	J. Am. Med. Dir. Assoc.
Volume:	23
Number:	9
Date:	2022
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1538-9375
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language COMPREHENSIVE GERIATRIC ASSESSMENT; ACUTE RESPIRATORY-FAILURE; NONINVASIVE VENTILATION; MORTALITY; VALIDATION; PEOPLE Multiple languages Geriatrics & Gerontology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/69368