LAUSR

The aim was to examine the predictive value of the record-based MPI in terms of mortality, readmission and LOS. The record-based MPI assessed at discharge predicted mortality and readmission risk in medical inpatients aged ≥ 75 years. Higher MPI risk scores were also associated with longer hospital stay, higher age and female sex. The record-based MPI is valuable in predicting mortality and other frailty-related, negative health outcomes in older medical inpatients, and the method is applicable as an alternative to bedside MPI in older hospitalized medical patients. To examine the predictive value of the record-based Multidimensional Prognostic Index (MPI) on mortality, readmission and length of hospital stay (LOS) among older medical inpatients. A cohort of medical inpatients aged ≥ 75 years was rated using the record-based MPI to assess frailty retrospectively. 90-day and 1-year mortality hazard ratios (HRs) were calculated in a sex- and age-adjusted Cox proportional hazards model. 30-day readmission relative risk (RR) estimates were calculated in a binary regression model with mortality as a competing risk. Discrimination was expressed by the area under the receiver operating characteristic (ROC) curve. Median LOS was calculated using the non-parametric Kruskal–Wallis one-way ANOVA. In total, 1190 patients with a median age of 83 years were included. 50% were male. 335 patients (28%) were categorized as non-frail (MPI score 0.0–0.33), 522 (44%) moderately frail (MPI score 0.34–0.66) and 333 (28%) severely frail (MPI score 0.67–1.0). 90-day mortality HR was 7.4 (95% confidence interval (CI) 2.9–18.6, p < 0.001) for the moderately frail and 18.5 (95% CI 7.5–46.1, p < 0.001) for the severely frail compared with the non-frail. ROC area was 0.76 (95% CI 0.72–0.80). Similarly, 1-year mortality HR was 3.3 (95% CI 2.2–5.0, p < 0.001) for the moderately frail and 7.1 (95% CI 4.7–10.6, p < 0.001) for the severely frail. 30-day readmission RR was 2.1 (95% CI 1.5–2.9, p < 0.001) for the moderately frail and 1.8 (95% CI 1.3–2.6, p = 0.001) for the severely frail. LOS was significantly longer with increasing MPI score (p < 0.001). The record-based MPI assessed at discharge predicts dose-dependent post-discharge mortality and readmission risk and is associated with LOS in older medical inpatients.