Validation and Adaptation of the Multidimensional Prognostic Index in an Older Australian Cohort

Background and aims: The Multidimensional Prognostic Index (MPI), an objective and quantifiable tool based on the Comprehensive Geriatric Assessment, has been shown to predict adverse outcomes in European cohorts. We conducted a validation study of the original MPI, and of adapted versions that accounted for the use of specific drugs and cultural diversity in the assessment of cognition, in older Australians. Methods: The capacity of the MPI to predict 12-month mortality was assessed in 697 patients (median age: 80 years; interquartile range: 72-86) admitted to a metropolitan teaching hospital between September 2015 and February 2017. Results: In simple logistic regression analysis, the MPI was associated with 12-month mortality (Low risk: OR reference group; moderate risk: OR 2.50, 95% CI: 1.67-3.75; high risk: OR 4.24, 95% CI: 2.28-7.88). The area under the receiver operating characteristic curve (AUC) for the unadjusted MPI was 0.61 (0.57-0.65) and 0.64 (95% CI: 0.59-0.68) with age and sex adjusted. The adapted versions of the MPI did not significantly change the AUC of the original MPI. Conclusion: The original and adapted MPI were strongly associated with 12-month mortality in an Australian cohort. However, the discriminatory performance was lower than that reported in European studies.