Table 1.
Clinical studies of development and validation of the Multidimensional Prognostic Index (MPI) and predictive values against different disease-specific prognostic indices.
| Disease | Patients number | Accuracy/risk AUC (95% CI) C-index, OR, or HR (95% CI) | Follow-up | Accuracy of other prognostic indices or disease-specific prognostic indices vs. MPI AUC or C-index (95% CI) | Follow-up |
|---|---|---|---|---|---|
| Acute diseases or exacerbations of chronic diseases (26) | Hospitalized Development cohort 838 | ||||
| Validation cohort 856 | 0.75 (0.70–0.80) 0.75 (0.71–0.80) | 6 months 1 year | |||
| Acute diseases or exacerbations of chronic diseases (27) | Hospitalized 4,088 | 0.76 (0.73–0.79) | 1 month | m-MPI = 0.75 (0.72–0.78) | |
| 0.72 (0.70–0.74) | 1 year | m-MPI = 0.71 (0.69–0.73) | |||
| Acute diseases or exacerbations of chronic diseases (34) | Hospitalized Multicenter 2,033 | 0.76 (0.72–0.80) | 1 month | FI-SOF = 0.685 (0.64–0.73) p < 0.0001 | |
| FI-CD = 0.738 (0.69–0.78) p < 0.0001 | |||||
| FI-CGA = 0.724 (0.68–0.77) p < 0.0001 | |||||
| 0.75 (0.72–0.78) | 1 year | FI-SOF = 0.69, 0.67–0.72, p < 0.0001 | |||
| FI-CD = 0.73, 0.70–0.76, p < 0.0001 | |||||
| FI-CGA = 0.73, 0.70–0.75, p < 0.0001 | |||||
| Acute diseases or exacerbations of chronic diseases (35) | Community Development cohort 7,876 | MPI-SVaMA C-index (95% CI) 0.83 (0.82–0.84) 0.80 (0.78–0.80) | 1 month 1 year | C-index Prognostic score: 0.82 [Lee et al. (49)] | 4 years |
| Combined comorbidity score: 0.79 [Gagne et al. (47)] | 1 year | ||||
| Validation cohort 4,144 | 0.83 (0.82–0.85) 0.79 (0.78–0.80) | 1 month 1 year | ASSIp prognostic index: 0.75 [Mazzaglia et al. (48)] | 15 months | |
| PACE prognostic index: 0.74 [Carey et al. (50)] | 2 years | ||||
| NHIS prognostic score: 0.75 [Schonberg et al. (51)] | 5 years | ||||
| Community-acquired pneumonia (37) | Hospitalized 134 | 0.83, 0.75–0.87 | 1 month | PSI = 0.71 (0.62–0.78) p = 0.019 | |
| 0.79, 0.71–0.85 | 6 months | PSI = 0.69 (0.61–0.77) p = 0.035 | |||
| 0.80, 0.72–0.86 | 1 year | PSI = 0.75 (0.65–0.82) p = 0.185 | |||
| Transient ischemic attack (41) | Hospitalized 654 | 0.82 (0.75–0.89) | 1 month | ||
| 0.80 (0.74–0.86) | 6 months | ||||
| 0.77 (0.72–0.82) | 1 year | ||||
| Gastrointestinal bleeding (42) | Hospitalized 91 | 0.76 (0.58–0.94) | 2 years | RRSS = 0.57 (0.40–0.74) | |
| GBS = 0.61 (0.42–0.80) | |||||
| Liver cirrhosis (42) | Hospitalized 129 | 0.90 (0.85–0.96) | 1 year | Child-Pugh score = 0.70 (0.52–0.88) p = 0.03 | |
| Dementia (38) | Hospitalized 262 | 0.77 (0.73–0.84) | 1 month | ||
| 0.78 (0.72–0.83) | 1 year | ||||
| Dementia (43) | Community 340 | MPI score: 0–1 | |||
| OR (95% CI) 6.50 (1.64–25.85) 9.53 (2.90–31.33) | 1 year 2.2 years | Risk of hospitalization Risk of mortality | |||
| Congestive heart failure (36) | Hospitalized 376 | Men: 0.83 (0.75–0.90) Women: 0.80 (0.71–0.89) | 1 month | NYHA: Men: 0.63 (0.57–0.69) p = 0.015; Women: 0.65 (0.55–0.75) p = 0.064 | |
| EFFECT: Men: 0.69 (0.58–0.79) p = 0.045; Women: 0.71 (0.55–0.87) p = 0.443 | |||||
| ADHERE: Men: 0.65 (0.52–0.78) p = 0.023; Women: 0.67 (0.49–0.83) p = 0.171 | |||||
| Chronic kidney disease (39) | Hospitalized 786 | 0.70 (0.66–0.73) | 1 year | eGFR = 0.58 (0.54–0.61) p < 0.001 | |
| Chronic kidney disease (40) | Hospitalized 1198 | C-Index (95% CI) 0.65 (0.62–0.68) | 2 years | eGFR without MPI = C-index: 0.58 (0.55–0.61) p < 0.0001 | |
| Adding MPI to eGFR, C-index increased from 0.58 to 0.65 (p < 0.0001) | |||||
| Inoperable or metastatic solid cancer (44) | Hospitalized 160 | 0.91 (0.87–0.96) | 6 months | ||
| 0.87 (0.82–0.93) | 1 year | ||||
| Acute diseases or exacerbations of chronic diseases (45) | Hospitalized 1,178 | In-hospital mortality: C-Index 0.85 (0.79–0.91) | |||
| HR (95% CI): MPI-1 Reference | |||||
| MPI-2 3.48 (1.02–11.88) | |||||
| MPI-3 8.31 (2.54–27.19) | |||||
| Length of stay: Mean (95%CI): MPI-1 11.29 (0.5) days; MPI-2 13.73 (1.3) days; MPI-3 15.30 (1.4) days | |||||
AUC, area under the curve; CI, confidence intervals; OR, odds ratio; HR, hazard ratio; m-MPI, MPI-Mini Nutritional Short-Form Examination; FI-SOF, Frailty Index from the Study of Osteoporotic Fractures; FI-CD, Frailty Index based on the Cumulative Deficit model; FI-CGA, Frailty Index based on a Comprehensive Geriatric Assessment; MPI-SVaMA, Multidimensional Prognostic Index-Standardized Multidimensional Assessment Schedule for Adults and Aged Persons; ASSIp, Assistenza Socio-Sanitaria in Italia project; PACE, Program of All-Inclusive Care for the Elderly; NHIS, National Health Interview Survey; PSI, Pneumonia Severity Score; RRSS, Rockall risk scoring system; GBS, Glasgow–Blatchford bleeding score; NYHA, New York Heart Association Functional Classification; EFFECT, Enhanced Feedback for Effective Cardiac Treatment; ADHERE, Acute Decompensated Heart Failure National Registry; eGFR, estimated Glomerular Filtration Rate.