The Multidimensional Prognostic Index (MPI) for the prognostic stratification of hospitalized older patients with COVID-19: a prospective multicenter observational cohort study. Objectives, study design and expected outcomes (MPI_COVID-19)
The emergent coronavirus-19 disease (COVID-19) pandemic posed and still poses serious issues in the management of the inpatients and in the resource allocation, in particular for those patients requiring Intensive Care Unit (ICU) management. Epidemiological data clearly suggest that multimorbid older patients have the poorest prognosis. However, it is conceivable that age and number of comorbidities alone do not reflect the real condition and the expected prognosis of the patients affected by COVID-19. A different approach based on comprehensive geriatric assessment (CGA) could help to better identify older patients more at risk of dismal outcomes and who, at some point of their clinical course, will need the ICU admission. The Multidimensional Prognostic Index (MPI) is a well-accepted tool derived from a standard CGA which allows to measure prognosis of older patients in different clinical settings including hospital. Therefore, we designed a multicenter, prospective, observational study to evaluate the role of MPI in predicting risk of ICU admission and in-hospital mortality among 500 COVID-19-positive older subjects admitted to geriatric and internal medicine wards. In addition, risk of re-hospitalization, institutionalization and death after 3 months from discharge will be assessed. The MPI yields a straightforward value from 0 to 1 and might be able to adequately stratify complex, vulnerable COVID-19 patients for best possible decision-making and treatment allocation.
Alberto Pilotto, Nicola Veronese, Carlo Sabbà, Francesco Mattace Raso, Alberto Cella, Maria Cristina Polidori, Carlo Custodero, Margherita Azzini, Filippo Fimognari