Publications by authors named "Alberto Cella"

19 Publications

  • Page 1 of 1

The multidimensional prognostic index (MPI) for the prognostic stratification of older inpatients with COVID-19: A multicenter prospective observational cohort study.

Arch Gerontol Geriatr 2021 Apr 5;95:104415. Epub 2021 Apr 5.

Department of Primary Care, District 3, ULSS 3, Venice, Italy,; Department of Internal Medicine and Geriatrics, University of Palermo, Italy. Electronic address:

Background: The topic of prognosis in COVID-19 research may be important in adopting appropriate clinical decisions. Multidimensional prognostic index (MPI) is a frailty assessment tool widely used for stratifying prognosis in older people, but data regarding inpatients, affected by COVID-19, are not available.

Objectives: To evaluate whether MPI can predict in-hospital mortality and the admission to intensive care unit (ICU) in older inpatients hospitalized for COVID-19 infection.

Methods: In this longitudinal, Italian, multi-center study, older patients with COVID-19 were included. MPI was calculated using eight different domains typical of comprehensive geriatric assessment and categorized in three groups (MPI 1 ≤ 0.33, MPI 2 0.34-0.66, MPI 3 > 0.66). A multivariable Cox's regression analysis was used reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: 227 older patients hospitalized for SARS-CoV-2 infection were enrolled (mean age: 80.5 years, 59% females). Inpatients in the MPI 3 were subjected less frequently than those in the MPI 1 to non-invasive ventilation (NIV). In the multivariable analysis, people in MPI 3 experienced a higher risk of in hospital mortality (HR = 6.30, 95%CI: 1.44-27.61), compared to MPI 1. The accuracy of MPI in predicting in hospital mortality was good (Area Under the Curve (AUC) = 0.76, 95%CI: 0.68-0.83). People in MPI 3 experienced a significant longer length of stay (LOS) in hospital compared to other participants. No association between MPI and ICU admission was found.

Conclusions: Frailty- as assessed by high MPI score - was associated with a significant higher risk of in-hospital mortality, longer LOS, and lower use NIV, whilst the association with ICU admission was not significant. These findings suggest that prognostic stratification by using the MPI could be useful in clinical decision making in older inpatients affected by COVID-19.
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http://dx.doi.org/10.1016/j.archger.2021.104415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020604PMC
April 2021

Multidimensional prognostic index (MPI) predicts non-invasive ventilation failure in older adults with acute respiratory failure.

Arch Gerontol Geriatr 2021 May-Jun;94:104327. Epub 2020 Dec 24.

Department of Interdisciplinary Medicine, University of Bari, Italy; Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genova, Italy. Electronic address:

Background: Acute respiratory failure (ARF) is a very common complication among hospitalized older adults. Non-invasive ventilation (NIV) may avoid admission to intensive care units, intubation and their related complication, but still lacks specific indications in older adults. Multidimensional Prognostic Index (MPI) based on comprehensive geriatric assessment (CGA) could have a role in defining the short-term prognosis and the best candidates for NIV among older adults with ARF.

Methods: This is a retrospective observational study which enrolled patients older than 70 years, consecutively admitted to an acute geriatric unit with ARF. A standardized CGA was used to calculate the MPI at admission. Multivariate Cox regression models were used to test if MPI score could predict in-hospital mortality and NIV failure. Receiver operator curve (ROC) analysis was used to identify the discriminatory power of MPI for NIV failure.

Results: We enrolled 231 patients (88.2 ± 5.9 years, 47% females). Mean MPI at admission was 0.76±0.16. In-hospital mortality rate was 33.8%, with similar incidence in patients treated with and without NIV. Among NIV users (26.4%), NIV failure occurred in 39.3%. Higher MPI scores at admission significantly predicted in-hospital mortality (β=4.46, p<0.0001) among patients with ARF and NIV failure (β=7.82, p = 0.001) among NIV users. MPI showed good discriminatory power for NIV failure (area under the curve: 0.72, 95% CI: 0.58-0.85, p<0.001) with optimal cut-off at MPI value of 0.84.

Conclusions: MPI at admission might be a useful tool to early detect patients more at risk of in-hospital death and NIV failure among older adults with ARF.
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http://dx.doi.org/10.1016/j.archger.2020.104327DOI Listing
December 2020

Association Between The Multidimensional Prognostic Index And Mortality Over 15 Years Of Follow-Up In The Inchianti Study.

J Gerontol A Biol Sci Med Sci 2020 Sep 17. Epub 2020 Sep 17.

Longitudinal Study Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA.

Background: Multidimensional Prognostic Index (MPI) is recognized as prognostic tool in hospitalized patients, but data on the value of MPI in community-dwelling older persons are limited. Using data from a representative cohort of community-dwelling persons, we tested the hypothesis that MPI explains mortality, over 15 years of follow-up.

Methods: A standardized comprehensive geriatric assessment was used to calculate the MPI and to categorize participants in low-, moderate-, and high-risk classes. The results were reported as hazard ratios (HRs) and the accuracy was evaluated with the AUC (area under the curve), with 95% confidence intervals (CIs) and the C-index. We also reported the median survival time by standard age groups.

Results: All 1,453 participants (mean age 68.9 years, women=55.8%) enrolled in the InCHIANTI study at baseline were included. Compared to low risk group, participants in moderate (HR=2.10; 95%CI: 1.73-2.55) and high MPI risk group (HR=4.94; 95%CI: 3.91-6.24) had significantly higher mortality risk. The C-index of the model containing age, sex, and MPI was 82.1, indicating a very good accuracy of this model in explaining mortality. Additionally, the time-dependent AUC indicated that the accuracy of the model incorporating MPI to age and sex was excellent (>85.0) during the whole follow-up period. Compared to participants in the low-risk MPI group across different age-groups, those in medium- and high-risk groups survived 2.9 to 7.0 years less and 4.3 to 8.9 years less, respectively.

Conclusions: In community-dwelling individuals, higher MPI values are associated with higher risk of all-cause mortality with a dose-response effect.
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http://dx.doi.org/10.1093/gerona/glaa237DOI Listing
September 2020

Development and validation of a robotic multifactorial fall-risk predictive model: A one-year prospective study in community-dwelling older adults.

PLoS One 2020 25;15(6):e0234904. Epub 2020 Jun 25.

Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Genova, Italy.

Background: Falls in the elderly are a major public health concern because of their high incidence, the involvement of many risk factors, the considerable post-fall morbidity and mortality, and the health-related and social costs. Given that many falls are preventable, the early identification of older adults at risk of falling is crucial in order to develop tailored interventions to prevent such falls. To date, however, the fall-risk assessment tools currently used in the elderly have not shown sufficiently high predictive validity to distinguish between subjects at high and low fall risk. Consequently, predicting the risk of falling remains an unsolved issue in geriatric medicine. This one-year prospective study aims to develop and validate, by means of a cross-validation method, a multifactorial fall-risk model based on clinical and robotic parameters in older adults.

Methods: Community-dwelling subjects aged ≥ 65 years were enrolled. At the baseline, all subjects were evaluated for history of falling and number of drugs taken daily, and their gait and balance were evaluated by means of the Timed "Up & Go" test (TUG), Gait Speed (GS), Short Physical Performance Battery (SPPB) and Performance-Oriented Mobility Assessment (POMA). They also underwent robotic assessment by means of the hunova robotic device to evaluate the various components of balance. All subjects were followed up for one-year and the number of falls was recorded. The models that best predicted falls-on the basis of: i) only clinical parameters; ii) only robotic parameters; iii) clinical plus robotic parameters-were identified by means of a cross-validation method.

Results: Of the 100 subjects initially enrolled, 96 (62 females, mean age 77.17±.49 years) completed the follow-up and were included. Within one year, 32 participants (33%) experienced at least one fall ("fallers"), while 64 (67%) did not ("non-fallers"). The best classifier model to emerge from cross-validated fall-risk estimation included eight clinical variables (age, sex, history of falling in the previous 12 months, TUG, Tinetti, SPPB, Low GS, number of drugs) and 20 robotic parameters, and displayed an area under the receiver operator characteristic (ROC) curve of 0.81 (95% CI: 0.72-0.90). Notably, the model that included only three of these clinical variables (age, history of falls and low GS) plus the robotic parameters showed similar accuracy (ROC AUC 0.80, 95% CI: 0.71-0.89). In comparison with the best classifier model that comprised only clinical parameters (ROC AUC: 0.67; 95% CI: 0.55-0.79), both models performed better in predicting fall risk, with an estimated Net Reclassification Improvement (NRI) of 0.30 and 0.31 (p = 0.02), respectively, and an estimated Integrated Discrimination Improvement (IDI) of 0.32 and 0.27 (p<0.001), respectively. The best model that comprised only robotic parameters (the 20 parameters identified in the final model) achieved a better performance than the clinical parameters alone, but worse than the combination of both clinical and robotic variables (ROC AUC: 0.73, 95% CI 0.63-0.83).

Conclusion: A multifactorial fall-risk assessment that includes clinical and hunova robotic variables significantly improves the accuracy of predicting the risk of falling in community-dwelling older people. Our data suggest that combining clinical and robotic assessments can more accurately identify older people at high risk of falls, thereby enabling personalized fall-prevention interventions to be undertaken.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234904PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316263PMC
September 2020

Relationship between multidimensional prognostic index and incident depressive symptoms in older people: Findings from the Irish Longitudinal Study on Ageing.

Int J Geriatr Psychiatry 2020 10 22;35(10):1097-1104. Epub 2020 Jun 22.

Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance & High Specialization Hospital, Genoa, Italy.

Objectives: The multidimensional prognostic index (MPI) is a useful prognostic tool for evaluating adverse health outcomes in older individuals. However, the association between MPI and depressive symptoms has never been explored, despite depression being a common condition in older people. We therefore aimed to evaluate whether MPI may predict incident depressive symptoms.

Methods: Longitudinal, cohort study, with 2 years of follow-up (W1: October 2009-February 2011; W2: April 2012-January 2013), including people aged ≥65 years without depressive symptoms at baseline. A comprehensive geriatric assessment including information on functional, nutritional, cognitive status, mobility, comorbidities, medications, and cohabitation status was used to calculate the MPI dividing the participants into low, moderate, or severe risk. Those who scored ≥16/60 with the Center of Epidemiology Studies Depression (CES-D) tool were considered to have depressive symptoms. Multivariable logistic regression models were built to explore the association between MPI and incident depressive symptoms.

Results: The sample consisted of 1854 participants (mean age: 72.8 ± SD 5.1 years; females: 52.1%). The prevalence of incident depressive symptoms by MPI tertiles at baseline were: low 2.5%, moderate 3.9%, and severe 6.7%. In multivariable analyses, baseline MPI values were significantly associated with incident depressive symptoms (increase in 0.1 points in MPI: odds ratio, OR = 1.47; 95% confidence intervals, CI: 1.17-1.85; MPI tertile severe vs low: OR = 2.96; 95%CI: 1.50-5.85).

Conclusion: Baseline MPI values were associated with incident depressive symptoms indicating that multidimensional assessment of older people may lead to early identification of individuals at increased risk of depression onset.
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http://dx.doi.org/10.1002/gps.5331DOI Listing
October 2020

Agreement of a Short Form of the Self-Administered Multidimensional Prognostic Index (SELFY-MPI-SF): A Useful Tool for the Self-Assessment of Frailty in Community-Dwelling Older People.

Clin Interv Aging 2020 30;15:493-499. Epub 2020 Mar 30.

Geriatric Unit, Department of Internal Medicine, Azienda Ospedaliera di Cosenza, Cosenza, Italy.

Background: The Multidimensional Prognostic Index (MPI) is a comprehensive geriatric assessment (CGA)-based tool that has shown excellent accuracy in predicting negative health outcomes in older people. Recently, the self-administered version of MPI (SELFY-MPI) has been validated in a community-dwelling sample, revealing excellent agreement with the original MPI. In the SELFY-MPI, Gijon's social-familial evaluation scale (SFES) was used to assess socio-relational and economic aspects. Completion of the SELFY-MPI, however, requires a significant amount of time in people aged over 60 years, particularly to fill in the SFES scale. The aim of this study was to validate, in a sample of community-dwelling older people, a short-form version of the SELFY-MPI (SELFY-MPI-SF), in which the SFES scale was replaced by the "co-habitation status" domain, as in the original version of the MPI.

Methods: All participants included in the study completed both versions of the self-administered MPI, which share the following seven domains: 1) basic and 2) instrumental activities of daily living, 3) mobility, 4) cognition, 5) nutrition, 6) comorbidity, and 7) number of medications. Moreover, in the SELFY-MPI-SF, the 8th domain "co-habitation status" (ie living alone, with family or in a residential facility) replaced the SFES scale. The Bland-Altman methodology was applied in order to measure the agreement between the two instruments. Finally, the time to complete the SFES scale and the question on co-habitation was measured.

Results: The final study sample was composed of 129 participants (mean age=76.8 years, range=65-93 years, 64.3% women) were enrolled. The mean SELFY-MPI and SELFY-MPI-SF values were 0.221±0.196 and 0.246± 0.188, respectively. The mean difference was clinically irrelevant (-0.025±0.058). None of the 129 observations showed values outside the established 5% limits of agreement. The agreement between SELFY-MPI and SELFY-MPI-SF was excellent (k=0.762; rho=0.924, p<0.0001 for both). Stratified analyses of agreement among subgroups of participants of different ages did not show any significant differences between the two versions. Completion of the SFES required about 7 mins, on average, while the question on habitation status required about 10 s.

Conclusion: The SELFY-MPI-SF showed strong agreement and precision when compared with the standard SELFY-MPI in people aged 65 and older and can therefore be successfully used as a quicker self-administered frailty instrument in community-dwelling older people.
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http://dx.doi.org/10.2147/CIA.S241721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125337PMC
September 2020

Comprehensive Geriatric Assessment in Cardiovascular Disease.

Adv Exp Med Biol 2020 ;1216:87-97

Intermediate Care Unit (Department of Geriatric Care, OrthoGeriatrics and Rehabilitation), E.O. Galliera Hospital, Genoa, Italy.

Frailty and cardiovascular disease (CVD) are both highly prevalent in older adults. Cardiovascular disease has been identified as the most frequent cause of death, while frailty has been identified as one of geriatric giants characterized by decreased physiological reserves and increased vulnerability. However, the exact pathobiological links between the two conditions have not been fully elucidated. Consequently, we observe a relevant difficulty not only in accurately defining cardiovascular risk in vulnerable elderly patients (and the other way around), but also a lack of consensus regarding CVD management in the very old. Nowadays, considering the enormous technical innovation, many elderly patients, if appropriately selected, could be eligible even for the most complex treatments, including invasive cardiological procedures. Identification of frail patients at risk of negative outcomes can allow the customization of therapeutic interventions in elderly patients with CVD, allowing the elderly who can benefit from them to undergo even invasive procedures and avoiding futile or dangerous treatments for the most vulnerable patients. A large number of tools and definitions for assessing frailty have been proposed; different scales and assessment tools can be useful for different purposes, but at present there is no clear indication for their use in CVD. In this chapter, we will describe the main geriatric approach to ascertain frailty, the assessment tools used in patients with cardiovascular diseases, and propose an operational strategy to evaluate frailty and identify patients eligible for pharmacologic or surgical interventions.
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http://dx.doi.org/10.1007/978-3-030-33330-0_10DOI Listing
February 2020

The Multidimensional Prognostic Index Predicts Falls in Older People: An 8-Year Longitudinal Cohort Study of the Osteoarthritis Initiative.

J Am Med Dir Assoc 2020 05 25;21(5):669-674. Epub 2019 Nov 25.

Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance & High Specialization Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari, Bari, Italy. Electronic address:

Objectives: Falls are associated with several negative outcomes. Early identification of those who are at risk of falling is of importance in geriatrics, and comprehensive geriatric assessment (CGA) seems to be promising in this regard. Therefore, the present study investigated whether the multidimensional prognostic index (MPI), based on a standard CGA, is associated with falls in the Osteoarthritis Initiative (OAI).

Design: Longitudinal, 8 years of follow-up.

Setting And Participants: Community-dwelling older people (≥65 years of age) with knee osteoarthritis or at high risk for this condition.

Methods: A standardized CGA including information on functional, nutritional, mood, comorbidities, medications, quality of life, and cohabitation status was used to calculate a modified version of the MPI, categorized as MPI-1 (low), MPI-2 (moderate), and MPI-3 (high risk). Falls were self-reported and recurrent fallers were defined as ≥2 in the previous year. Logistic regression was carried out and results are reported as odds ratio (ORs) with their 95% confidence intervals (CIs).

Results: The final sample consisted of 885 older adults (mean age 71.3 years, female = 54.6%). Recurrent fallers showed a significant higher MPI than their counterparts (0.46 ± 0.17 vs 0.38 ± 0.16; P < .001). Compared with those in MPI-1 category, participants in MPI-2 (OR 2.13; 95% CI 1.53‒2.94; P < .001) and in MPI-3 (OR 5.98; 95% CI 3.29-10.86; P < .001) reported a significant higher risk of recurrent falls over the 8-years of follow-up. Similar results were evident when using an increase in 0.1 points in the MPI or risk of falls after 1 year.

Conclusions And Implications: Higher MPI values at baseline were associated with an increased risk of recurrent falls, suggesting the importance of CGA in predicting falls in older people.
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http://dx.doi.org/10.1016/j.jamda.2019.10.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186147PMC
May 2020

Robotic balance assessment in community-dwelling older people with different grades of impairment of physical performance.

Aging Clin Exp Res 2020 Mar 5;32(3):491-503. Epub 2019 Nov 5.

Department of Geriatric Care, Orthogeriatrics and Rehabilitation, EO Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy.

Background: Impaired physical performance is common in older adults and has been identified as a major risk factor for falls. To date, there are no conclusive data on the impairment of balance parameters in older subjects with different levels of physical performance.

Aims: The aim of this study was to investigate the relationship between different grades of physical performance, as assessed by the Short Physical Performance Battery (SPPB), and the multidimensional balance control parameters, as measured by means of a robotic system, in community-dwelling older adults.

Methods: This study enrolled subjects aged ≥ 65 years. Balance parameters were assessed by the hunova robot in static and dynamic (unstable and perturbating) conditions, in both standing and seated positions and with the eyes open/closed.

Results: The study population consisted of 96 subjects (62 females, mean age 77.2 ± 6.5 years). According to their SPPB scores, subjects were separated into poor performers (SPPB < 8, n = 29), intermediate performers (SPPB = 8-9, n = 29) and good performers (SPPB > 9, n = 38). Poor performers displayed significantly worse balance control, showing impaired trunk control in most of the standing and sitting balance tests, especially in dynamic (both with unstable and perturbating platform/seat) conditions.

Conclusions: For the first time, multidimensional balance parameters, as detected by the hunova robotic system, were significantly correlated with SPPB functional performances in community-dwelling older subjects. In addition, balance parameters in dynamic conditions proved to be more sensitive in detecting balance impairments than static tests.
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http://dx.doi.org/10.1007/s40520-019-01395-0DOI Listing
March 2020

Older women are frailer, but less often die then men: a prospective study of older hospitalized people.

Maturitas 2019 Oct 3;128:81-86. Epub 2019 Aug 3.

Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Geriatric Unit, National Relevance & High Specialization Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, 'Aldo Moro' University of Bari, Italy. Electronic address:

Objectives: The association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital.

Study Design: We used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up.

Main Outcome Measures: People aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and co-habitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year.

Results: Altogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27-4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50-2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34-0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06-1.91) during the year after hospital discharge.

Conclusion: Older hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the 'male-female health-survival paradox' to acutely ill patient groups.
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http://dx.doi.org/10.1016/j.maturitas.2019.07.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7461698PMC
October 2019

Enteral tube feeding and mortality in hospitalized older patients: A multicenter longitudinal study.

Clin Nutr 2020 05 22;39(5):1608-1612. Epub 2019 Jul 22.

Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Geriatric Unit, E.O. Galliera Hospital, Genova, Italy; Department of Interdisciplinary Medicine, 'Aldo Moro' University of Bari, Italy.

Background & Aims: The literature regarding enteral nutrition and mortality in older frail people is limited and still conflicting. Moreover, the potential role of comprehensive geriatric assessment is poorly explored. We therefore aimed to investigate whether the Multidimensional Prognostic Index (MPI), an established tool that assesses measures of frailty and predicts mortality, may help physicians in identifying patients in whom ETF (enteral tube feeding) is effective in terms of reduced mortality.

Methods: Observational, longitudinal, multicenter study with one year of follow-up. Data regarding ETF were recorded through medical records. A standardized comprehensive geriatric assessment was used to calculate the MPI. Participants were divided in low (MPI-1), moderate (MPI-2) or severe (MPI-3) risk of mortality. Data regarding mortality were recorded through administrative information.

Results: 1064 patients were included, with 79 (13 in MPI 1-2 and 66 in MPI-3 class) receiving ETF. In multivariable analysis, patients receiving ETF experienced a higher risk of death (odds ratio, OR = 2.00; 95% confidence intervals, CI: 1.19-3.38). However, after stratifying for their MPI at admission, mortality was higher in MPI-3 class patients (OR = 2.03; 95%CI: 1.09-3.76), but not in MPI 1-2 class patients (OR = 1.51; 95%CI: 0.44-5.25). The use of propensity score confirmed these findings.

Conclusions: ETF is associated with a higher risk of death. However, this is limited to more frail patients, suggesting the importance of the MPI in the prognostic evaluation of ETF.
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http://dx.doi.org/10.1016/j.clnu.2019.07.011DOI Listing
May 2020

Development and Validation of a Self-Administered Multidimensional Prognostic Index to Predict Negative Health Outcomes in Community-Dwelling Persons.

Rejuvenation Res 2019 Aug 28;22(4):299-305. Epub 2018 Dec 28.

6SESPA, Health Service of the Principality of Asturias, Oviedo, Spain.

The multidimensional prognostic index (MPI) is a comprehensive geriatric assessment (CGA)-based tool that accurately predicts negative health outcomes in older subjects with different diseases and settings. To calculate the MPI several validated tools are assessed by health care professionals according to the CGA, whereas self-reported information by the patients is not available, but it could be of importance for the early identification of frailty. We aimed to develop and validate a self-administered MPI (SELFY-MPI) in community-dwelling subjects. For this reason, we enrolled 167 subjects (mean age = 67.3, range = 20-88 years, 51% = men). All subjects underwent a CGA-based assessment to calculate the MPI and the SELFY-MPI. The SELFY-MPI included the assessment of (1) basic and instrumental activities of daily living, (2) mobility, (3) memory, (4) nutrition, (5) comorbidity, (6) number of medications, and (7) socioeconomic situation. The Bland-Altman methodology was used to measure the agreement between MPI and SELFY-MPI. The mean MPI and SELFY-MPI values were 0.147 and 0.145, respectively. The mean difference was +0.002 ± standard deviation of 0.07. Lower and upper 95% limits of agreement were -0.135 and +0.139, respectively, with only 5 of 167 (3%) of observations outside the limits. Stratified analysis by age provided similar results for younger (≤65 years old,  = 45) and older subjects (>65 years,  = 122). The analysis of variances in subjects subdivided according to different year decades showed no differences of agreement according to age. In conclusion, the SELFY-MPI can be used as a prognostic tool in subjects of different ages.
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http://dx.doi.org/10.1089/rej.2018.2103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6763964PMC
August 2019

Multidimensional Prognostic Index and pro-adrenomedullin plasma levels as mortality risk predictors in older patients hospitalized with community-acquired pneumonia: a prospective study.

Panminerva Med 2018 Sep 15;60(3):80-85. Epub 2018 Mar 15.

Department of Laboratory Medicine, Azienda ULSS 6 Euganea and Azienda Ospedaliera, Padua, Italy.

Background: To evaluate the prognostic accuracy of proadrenomedullin (proADM) in comparison with and in addition to the Multidimensional Prognostic Index (MPI), a validated predictive tool for mortality derived from a comprehensive geriatric assessment (CGA) to predict one-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP).

Methods: All patients aged 65 years and older, consecutively admitted to an acute geriatric ward with a diagnosis of CAP from February to July 2012. At admission and at discharge they were submitted to a standard CGA in order to calculate MPI. Moreover, plasma samples were taken at baseline and after one, three and five days of hospitalization for the analysis of pro-ADM.

Results: Fifty patients (mean age 86.2±7.5 years), with 31 at high risk of mortality (MPI-3) were enrolled. ProADM and MPI, both at admission and at discharge, were significant predictor of mortality. As expected, MPI at admission showed lower predictive accuracy than MPI at discharge (survival C-statistic 0.667 vs. 0.851). The addition of proADM to the MPI at admission significantly increased accuracy in predicting one-month mortality (C-statistics from 0.667 to 0.731, P=0.018 at baseline; from 0.667 to 0.733, P=0.008 at 1 day; from 0.633 to 0.724; P=0.019 at 3 days; from 0.667 to 0.828; P=0.003 at 5 days). Conversely, adding pro-ADM to the MPI at discharge did not significantly improve the model's prognostic accuracy.

Conclusions: ProADM may significantly improve the prognostic accuracy of the MPI at admission in hospitalized elderly patients with CAP.
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http://dx.doi.org/10.23736/S0031-0808.18.03408-0DOI Listing
September 2018

Combined use of the multidimensional prognostic index (MPI) and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP): a prospective study.

Aging Clin Exp Res 2018 Feb 17;30(2):193-197. Epub 2017 Apr 17.

Department of Laboratory Medicine, Azienda ULSS 16 and Azienda Ospedaliera, Padova, Italy.

Background: Several scores and biomarkers, i.e., procalcitonin (PCT), were proposed to stratify the mortality risk in community-acquired pneumonia (CAP).

Aim: Evaluating prognostic accuracy of PCT and Multidimensional Prognostic Index (MPI) for 1-month mortality risk in older patients with CAP.

Methods: At hospital admission and at discharge, patients were evaluated by a Comprehensive Geriatric Assessment to calculate MPI. Serum PCT was measured at admission and 1, 3, and 5 days after hospital admission.

Results: 49 patients were enrolled. The overall 1-month mortality was 44.5 for 100-persons year. Mortality rates were higher with the increasing of MPI. In survived patients, MPI at discharge showed higher predictive accuracy than MPI at admission. Adding PCT levels to admission MPI prognostic accuracy for 1-month mortality significantly increased.

Conclusion: In older patients with CAP, MPI significantly predicted 1 month mortality. PCT levels significantly improved the accuracy of MPI at admission in predicting 1-month mortality.
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http://dx.doi.org/10.1007/s40520-017-0759-yDOI Listing
February 2018

Three Decades of Comprehensive Geriatric Assessment: Evidence Coming From Different Healthcare Settings and Specific Clinical Conditions.

J Am Med Dir Assoc 2017 Feb 31;18(2):192.e1-192.e11. Epub 2016 Dec 31.

Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Clinical Research in Neurology, University of Bari Aldo Moro, Pia Fondazione Cardinale G. Panico, Tricase, Lecce, Italy; Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy. Electronic address:

Comprehensive geriatric assessment (CGA) is a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional capabilities of older adults to develop a coordinated plan to maximize overall health with aging. Specific criteria used by CGA programs to evaluate patients include age, medical comorbidities, psychosocial problems, previous or predicted high healthcare utilization, change in living situation, and specific geriatric conditions. However, no universal criteria have been agreed upon to readily identify patients who are likely to benefit from CGA. Evidence from randomized controlled trials and large systematic reviews and meta-analyses suggested that the healthcare setting may modify the effectiveness of CGA programs. Home CGA programs and CGA performed in the hospital were shown to be consistently beneficial for several health outcomes. In contrast, the data are conflicting for posthospital discharge CGA programs, outpatient CGA consultation, and CGA-based inpatient geriatric consultation services. The effectiveness of CGA programs may be modified also by particular settings or specific clinical conditions, with tailored CGA programs in older frail patients evaluated for preoperative assessment, admitted or discharged from emergency departments and orthogeriatric units or with cancer and cognitive impairment. CGA is capable of effectively exploring multiple domains in older age, being the multidimensional and multidisciplinary tool of choice to determine the clinical profile, the pathologic risk and the residual skills as well as the short- and long-term prognosis to facilitate the clinical decision making on the personalized care plan of older persons.
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http://dx.doi.org/10.1016/j.jamda.2016.11.004DOI Listing
February 2017

Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease.

Am J Cardiol 2016 Dec 30;118(11):1624-1630. Epub 2016 Aug 30.

Division of Geriatric Cardiology and Medicine, University of Florence, Florence, Italy.

Clinical decision-making for statin treatment in older patients with coronary artery disease (CAD) is under debate, particularly in community-dwelling frail patients at high risk of death. In this retrospective observational study on 2,597 community-dwelling patients aged ≥65 years with a previous hospitalization for CAD, we estimated mortality risk assessed with the Multidimensional Prognostic Index (MPI), based on the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA), used to determine accessibility to homecare services/nursing home admission in 2005 to 2013 in the Padua Health District, Veneto, Italy. Participants were categorized as having mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), and high (MPI-SVaMA-3) baseline mortality risk, and propensity score-adjusted hazard ratios (HRs) of 3-year mortality rate were calculated according to statin treatment in these subgroups. Greater MPI-SVaMA scores were associated with lower rates of statin treatment and higher 3-year mortality rate (MPI-SVaMA-1 = 23.4%; MPI-SVaMA-2 = 39.1%; MPI-SVaMA-3 = 76.2%). After adjusting for propensity score quintiles, statin treatment was associated with lower 3-year mortality risk irrespective of MPI-SVaMA group (HRs [95% confidence intervals] 0.45 [0.37 to 0.55], 0.44 [0.36 to 0.53], and 0.28 [0.21 to 0.39] in MPI-SVaMA-1, -2, and -3 groups, respectively [interaction test p = 0.202]). Subgroup analyses showed that statin treatment was also beneficial irrespective of age (HRs [95% confidence intervals] 0.38 [0.27 to 0.53], 0.45 [0.38 to 0.54], and 0.44 [0.37 to 0.54] in 65 to 74, 75 to 84, and ≥85 year age groups, respectively [interaction test p = 0.597]). In conclusion, in community-dwelling frail older patients with CAD, statin treatment was significantly associated with reduced 3-year mortality rate irrespective of age and multidimensional impairment, although the frailest patients were less likely to be treated with statins.
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http://dx.doi.org/10.1016/j.amjcard.2016.08.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121726PMC
December 2016

Frailty is associated with socioeconomic and lifestyle factors in community-dwelling older subjects.

Aging Clin Exp Res 2017 Aug 27;29(4):721-728. Epub 2016 Aug 27.

Department Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization, Genova, Italy.

Background And Aims: This study assessed the association between frailty and sociodemographic, socioeconomic and lifestyle factors in community-dwelling older people.

Methods: This was a cross-sectional survey in a population-based sample of 542 community-dwelling subjects aged 65 years and older living in a metropolitan area in Italy. Frailty was evaluated by means of the FRAIL scale proposed by the International Association of Nutrition and Aging. Basal and instrumental activities of daily living (ADL, IADL), physical activity, sociodemographic (age, gender, marital status and cohabitation), socioeconomic (education, economic conditions and occupational status) and lifestyle domains (cultural and technological fruition and social activation) were assessed through specific validated tools. Statistical analysis was performed through multinomial logistic regression.

Results: Impairments in ADL and IADL were significantly associated with frailty, while moderate and high physical activity were inversely associated with frailty. Moreover, regarding both socioeconomic variables and lifestyle factors, more disadvantaged socioeconomic conditions and low levels of cultural fruition were significantly associated with frailty.

Conclusions: Socioeconomic and lifestyle factors, particularly cultural fruition, are associated with frailty independently from functional impairment and low physical activity. Cultural habits may therefore represent a new target of multimodal interventions against geriatric frailty.
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http://dx.doi.org/10.1007/s40520-016-0623-5DOI Listing
August 2017

Development of an oncological-multidimensional prognostic index (Onco-MPI) for mortality prediction in older cancer patients.

J Cancer Res Clin Oncol 2016 May 12;142(5):1069-77. Epub 2016 Jan 12.

Department of Clinical and Experimental Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy.

Purpose: A multidimensional prognostic index (MPI) based on a comprehensive geriatric assessment (CGA) has been developed and validated in independent cohorts of older patients demonstrating good accuracy in predicting one-year mortality. The aim of this study was to develop a cancer-specific modified MPI (Onco-MPI) for mortality prediction in older cancer patients.

Methods: We enrolled 658 new cancer subjects ≥70 years (mean age 77.1 years, 433 females, 65.8 %) attending oncological outpatient services from September 2004 to June 2011. The Onco-MPI was calculated according to a validated algorithm as a weighted linear combination of the following CGA domains: age, sex, basal and instrumental activities of daily living, Eastern Cooperative Oncology Group performance status, mini-mental state examination, body mass index, Cumulative Illness Rating Scale, number of drugs and the presence of caregiver. Cancer sites (breast 46.5 %, colorectal 21.3 %, lung 6.4 %, prostate 5.5 %, urinary tract 5.0 %, other 15.3 %) and cancer stages (I 37 %, II 22 %, III 19 %, IV 22 %) were also included in the model. All-cause mortality was recorded. Three grades of severity of the Onco-MPI score (low risk: 0.0-0.46, medium risk: 0.47-0.63, high risk: 0.64-1.0) were calculated using RECPAM method. Discriminatory power and calibration were assessed by estimating survival C-indices, along with 95 % confidence interval (CI) and the survival-based Hosmer-Lemeshow (HL) measures.

Results: One-year mortality incidence rate was 17.4 %. A significant difference in mortality rates was observed in Onco-MPI low risk compared to medium- and high-risk patients (2.1 vs. 17.7 vs. 80.8 %, p < 0.0001). The discriminatory power of one-year mortality prediction of the Onco-MPI was very good (survival C-index 0.87, 95 % CI 0.84-0.90) with an excellent calibration (HL p value 0.854).

Conclusion: Onco-MPI appears to be a highly accurate and well-calibrated predictive tool for one-year mortality in older cancer patients that can be useful for clinical decision making in this age group.
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http://dx.doi.org/10.1007/s00432-015-2088-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828483PMC
May 2016