The Multidimensional Prognostic Index (MPI) is a prognostic tool based on a standard Comprehensive Geriatric Assessment (CGA) that predicts short- and long-term mortality in elderly subjects
What is the Multidimensional Prognostic Index?
The Multidimensional Prognostic Index (MPI) is a prognostic tool based on a standard Comprehensive Geriatric Assessment (CGA) that predicts short- and long-term mortality in elderly subjects. The MPI includes 63 items distributed in 8 domains of CGA as follows:
- Activities of Daily Living (ADL): 6 items
- Instrumental Activities of Daily Living (IADL): 8 items
- Short Portable Mental Status Questionnaire (SPMSQ): 10 items
- Mini Nutritional Assessement (MNA): 18 items
- Exton-Smith Scale (ESS): 5 items
- Cumulative Index Rating Scale – Comorbidity Index (CIRS-CI): 14 items
- Number of drugs used: 1 item
- Co-habitation status: 1 item
How can the Multidimensional Prognostic Index be used?
On the basis of MPI values, it is possible to calculate the short- and long-term mortality risk of the older subjects and to define the severity grade of mortality risk: low, moderate and severe. Several studies showed that the prognostic accuracy of the aggregated MPI was significantly greater than the prognostic accuracy of its individual components considered singularly. Thus the multidimensional approach can be successfully used in elderly patients for both clinical and administrative purposes.
Development and validation of the Multidimensional Prognostic Index
A cluster analysis on CGA data was made for evaluating the independence of variables and identifying the most relevant CGA domains in predicting mortality outcome. Following a step-wise method, other domains of the CGA were progressively included in the model in order to obtain the best combination of different CGA domains for the best prognostic accuracy. Clinical results confirmed that MPI had a good prognostic effect on short- and long-term mortality with a close agreement between the estimated and the observed mortality. The MPI was also successfully validated in elderly patients affected with several acute and chronic diseases such as gastrointestinal bleeding, pneumonia, heart failure, dementia, liver cirrhosis, chronic kidney disease and transient ischemic attack.
Utilization of Calculate-MPI
Through the following link is possible to download the program Calculate-MPI to calculate the Multidimensional Prognostic Index. The program is an .exe file and allows to run out the tests to obtain the numeric value of the single domain (ADL, IADL, SPMSQ, CIRS, MNA, ESS, drugs, co-habitation). Tests are available also in PDF format printable from this page. The program allows to print the final MPI result.
Interpretation of results
The MPI value ranges from 0,0 (lower risk) and 1,0 (higher risk of mortality) If the MPI value is between 0 and 0,33 the mortality risk is defined low (MPI 1); if the value is between 0,34 and 0,66 the mortality risk is defined moderate (MPI 2); if the value is between 0,66 and 1,00 the mortality risk is defined severe (MPI 3).
Technical features for an optimal program working
Operating system: Windows XP, Vista
Screen setting: not less than 1024x768 pixels
- Pilotto A, Ferrucci L, Franceschi M et al. Development and Validation of a Multidimensional Prognostic Index for One-Year Mortality from Comprehensive Geriatric Assessment in Hospitalized Older Patients. Rejuvenation Res 2008;11:151-161.
- Pilotto A, Addante F, Ferrucci L et al. The Multidimensional Prognostic Index (MPI) predicts short and long-term mortality in older patients with community-acquired pneumonia. J Gerontol A Biol Med Sci 2009;64:880-887.
- Pilotto A, Addante F, D’Onofrio G, Sancarlo D, Ferrucci L. The Comprehensive Geriatric Assessment and the multidimensional approach. A new look at the older patient with gastroenterological disorders. Best Pract Res Clin Gastroenterol 2009;23: 829-37.
- Pilotto A, Sancarlo D, Panza et al. The Multidimensional Prognostic Index (MPI) Based on a Comprehensive Geriatric Assessment Predicts Short- and Long-term Mortality in Hospitalized Older Patients with Dementia. J Alzheimers Dis 2009;18: 191-9.
- Pilotto A, Addante F, Franceschi M et al. A Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment predicts short-term mortality in older patients with heart failure. Circ Heart Fail 2010; 3: 14-20.
- Pilotto A, Sancarlo D, Franceschi M et al. A multidimensional approach to the geriatric patient with chronic kidney disease. J Nephrol 2010; 23: S5-10.
- Sancarlo D, Pilotto A, Panza F et al. A Multidimensional Prognostic Index (MPI) based on a Comprehensive Geriatric Assessment predicts short- and long-term all-cause mortality in hospitalized older patients with Transient Ischemic Attach. J Neurol 2011 Sep 23. [Epub ahead of print] DOI 10.1007/s00415-011-6241-4