Anziano fragile e decisioni cliniche: il progetto MPI-COVID-19 - Ospedali Galliera
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Anziano fragile e decisioni cliniche:
il progetto MPI-COVID-19
Alberto Pilotto
Direttore SC e UOC Geriatria a Direzione Universitaria
Direttore Dipartimento Cure Geriatriche, OrtoGeriatria e Riabilitazione
E.O. Ospedali Galliera, Genova, Italy
Professore Straordinario di Prima Fascia in Geriatria
Dipartimento Interdisciplinare di Medicina - Università degli Studi di Bari, Italy
Presidente Società Italiana Geriatria Ospedale e Territorio (SIGOT)
The unavoidable costs of frailty: a
geriatric perspective in the time of
COVID-19
Polidori MC, Maggi S, Mattace-Raso F, Pilotto A
Geriatric Care 2020; 6:8989 (March 2020)
The effect of frailty on survival in patients with
COVID-19 (COPE): a multicentre, European,
observational cohort study
Hewitt J et al, thelancet.com/public-health August 2020
Beyond Chronological Age: Frailty and
Multimorbidity Predict In-Hospital Mortality in
Patients With Coronavirus Disease 2019
Marengoni et al, J Gerontol A Biol Sci Med Sci 2021; 76: e38
Mortality attributable to COVID-19 in
nursing home residents: a retrospective
study
Veronese et al, ACER 2021, published online 24 April 2021
English version
Special Interest Group on Comprehensive
Geriatric Assessment (SIG-on-CGA)
THE MULTIDIMENSIONAL PROGNOSTIC INDEX (MPI) FOR THE
PROGNOSTIC STRATIFICATION OF HOSPITALIZED OLDER PATIENTS
WITH COVID-19: A PROSPECTIVE OBSERVATIONAL COHORT STUDY
(MPI_COVID-19)
OBJECTIVES To evaluate if the MPI can predict in Covid-19 older patients:
Primary 1) the admission to ICU;
2) In-hospital mortality.
Secondary To assess after 3-months whether the MPI predicts:
1) the length of stay; 2) rehospitalization; 3) admission in long-
term care facility; 4) mortality
Ethical Approval Date: 07.04.2020, N. Register CER Liguria 131/2020 – DB id 10442
Emendment N.1: 20/04/2020
CENTERS 5 Centers in Italy: Genova, Verona, Brescia, Catanzaro, Sanremo
5 Centers in Europe: Madrid, Lisboa, Prague, Oldenburg, Goettingen
The multidimensional prognostic index (MPI) for the prognostic
stratification of older inpatients with COVID-19: A multicenter
prospective observational cohort study
227 patients with COVID-19, mean age: 80.5 years, 59% females
MPI CGA-based categorized in MPI-1 (N. 60), MPI-2 (N.67), MPI-3 (N.100)
MPI-1
MPI-2
MPI-3
Conclusions Prognostic stratification, as assessed by the MPI, was associated with a
significant different risk of in-hospital mortality, LOS and NIV. These findings are of importance
for finally introducing prognostic factors derived from CGA in daily clinical practice in hospital,
and not only age that our study, again, has indicated as poor prognostic factor.
Pilotto et al, Arch Gerontol Geriatr 2021; 95:104415
The multidimensional prognostic index (MPI) for the prognostic
stratification of older inpatients with COVID-19: A multicenter
prospective observational cohort study
227 patients with COVID-19, mean age: 80.5 years, 59% females
MPI CGA-based categorized in MPI-1 (N. 60), MPI-2 (N.67), MPI-3 (N.100)
Pilotto et al, Arch Gerontol Geriatr 2021; 95:104415
Multidimensional prognostic index (MPI) predicts non-invasive
ventilation failure in older adults with acute respiratory failure
231 patients with ARF, mean age 88.2 ± 5.9 years, F 47%, 57 NIV treated
Mean MPI at admission was 0.76±0.16. In-hospital mortality rate 33.8%
Conclusions The CGA-based MPI performed at hospital admission could refine the patient
selection for NIV to maximize the chances of a successful outcome. Subjects with MPI lower
than 0.84 should be the optimal candidates for NIV treatment.
Custodero et al, Arch Gerontol Geriatr 2021; 94:104327
Frailty trajectories in community-dwelling older adults during COVID-
19 pandemic: the PRESTIGE study
Table 2. Predictors of worsening of frailty condition
during COVID-19 pandemic
Figure 2. Trajectories of frailty assessed Independent Worsening of frailty status
by SELFY-MPI-SF category at baseline. variable (ΔMPI ≥0.1)*
Adjusted 95% CI p-value
OR
Age ≥ 75y 3.53 1.10 – 11.36 0.035
Female 2.01 0.91 – 4.43 0.085
Multimorbidity (≥3 0.30 0.10 – 0.90 0.032
chronic diseases)
COVID-19 positive 1.01 0.35 – 2.9 0.989
MPI grade 1 REF
MPI grade 2-3 13.60 4.01 – 46
“Ageism” Is Associated With Self-Reported
Multidimensional Frailty in Community-Dwelling
Older Subjects: A Population-Based Study
Sabrina Zora, Alberto Cella, Stefano Poli, Nicola Veronese, Elena Zini, Paola Giannoni, Valeria Pandolfini,
Claudio Torrigiani and Alberto Pilotto
1,337 community-dwelling subjects over-65; structured questionnaire to collect psycho-socio-economic
and behavioral information. SELFY-Multidimensional Prognostic Index Short-Form (SELFY-MPI-SF).
Perceived Age Discrimination (PAD), over the past 5 years, was assessed based on explicit criteria.
In conclusion, self-reported frailty and negative affectivity are independently associated with
PAD in community-dwelling older people. Interventions to prevent and treat frailty could be
useful to reduce ageism and improve the well-being of the older people.
Zora et al. Frontiers in Medicine accepted: in press 2022
Multidimensional frailty and quality of life: a longitudinal
analysis of the English Longitudinal Study of Ageing
Nicola Veronese1, Marianna Noale2, Alberto Cella3, Carlo Custodero4, Lee Smith5, Marina Barbagelata3, Stefania Maggi2, Mario
Barbagallo1, Carlo Sabbà4, Luigi Ferrucci6, Alberto Pilotto3,4
Methods: Multidimensional frailty by MPI (Multidimensional Prognostic Index); Good Quality of Life
Expectancy indicators (GQoLE - Sullivan Method); mortality by administrative data.
Results: 6,244 participants (mean age: 71.8 years, 44.5% males) were followed-up for 10 years.
People in the moderate and severe MPI risk groups reported lower GQoLE values than
their counterparts, independently from age and gender.
Qual Life Res 2022 May 17. doi:10.1007/s1136-022-03152-9
Comprehensive geriatric assessment in older
people: an umbrella review of health outcomes
NICOLA VERONESE, CARLO CUSTODERO, JACOPO DEMURTAS, LEE SMITH, MARIO BARBAGALLO, STEFANIA MAGGI, ALBERTO CELLA,
NICOLA VANACORE, PIERANGELO LORA APRILE, LUIGI FERRUCCI, ALBERTO PILOTTO, The Special Interest Group in Meta-analysis
and Systematic Reviews and The Special Interest Group of the Comprehensive Geriatric Assessment of the
European Geriatric Medicine Society (EuGMS)
1,683 papers screened
31 systematic reviews
19 with meta-analysis
279,744 subjects included
13/53 outcomes significant
Age Ageing 2022 May 1; 51: doi:10.1093/ageing/afac104Comprehensive geriatric assessment in older
people: an umbrella review of health outcomes
NICOLA VERONESE, CARLO CUSTODERO, JACOPO DEMURTAS, LEE SMITH, MARIO BARBAGALLO, STEFANIA MAGGI, ALBERTO CELLA,
NICOLA VANACORE, PIERANGELO LORA APRILE, LUIGI FERRUCCI, ALBERTO PILOTTO, The Special Interest Group in Systematic
Reviews and Meta-analysis and The Special Interest Group of the Comprehensive Geriatric Assessment of the
European Geriatric Medicine Society (EuGMS)
1,683 papers screened
31 systematic reviews
19 with meta-analysis
279,744 subjects included
13/53 outcomes significant
Age Ageing 2022 May 1; 51: doi:10.1093/ageing/afac104Dove posso trovare gli strumenti MPI?
Gli strumenti MPI, multi-lingue sono pubblicati alla voce «Strumenti» sul sito
multiplat-age.it
I software sono scaricabili gratuitamente nel desktop,
per Sistemi Operativi Windows/MacOS XGrazie per l’ attenzione
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