Patient- vs organ-based prognostic tools for older patients in critical care units : An observational study with a 3-month follow-up.

Background: Anticipating a doubling of older adults in Europe by 2050, healthcare systems face substantial challenges, particularly in critical care units. However, there is still a lack of evidence-based knowledge for treating and assessing mortality risk in older patients. This study compared the predictive accuracy of two assessment tools for long-term outcomes among older patients: the Multidimensional Prognostic Index (MPI) and the Sequential Organ Failure Assessment (SOFA). As the MPI is based on a more holistic assessment, it may provide a more accurate prediction than the organ-based SOFA.

Objective: Does the MPI provide a more accurate prediction of mortality risk and quality of life for older patients in critical care units than the organ-based SOFA score?

Methods: In a 6-month study, 96 patients aged 65 and older admitted to intensive (ICU) or intermediate care units (IMC) were enrolled to assess 90-day mortality using a comprehensive geriatric assessment-based MPI and the SOFA score. The follow-up (FU) involved telephone assessments 30 and 90 days after admission, focusing on posthospitalization health and quality of life.

Results: Both MPI (p = 0.039) and SOFA score (p = 0.014) successfully predicted mortality among older IMC and ICU patients in logistic regressions. Receiver operating characteristic (ROC) analyses demonstrated comparable areas under the curve (AUCs) for MPI (0.618) and SOFA score (0.621), as well as a similar sensitivity and specificity (MPI 61.0% and 52.9%; SOFA score: 68.9% and 45.1%, respectively). The MPI at admission moreover correlated significantly with quality of life (p < 0.001, r = -0.631 at discharge; p = 0.005, r = -0.377 at 30-day FU; p = 0.004, r = -0.409 at 90-day FU) and nursing needs (Mann-Whitney U‑test, p = 0.002 at 30-day FU; p = 0.011 at 90-day FU) at FU, while the SOFA score did not show significant associations with respect to these parameters.

Conclusions: In geriatric critical care, both the MPI and the SOFA score effectively predict mortality risk. While the SOFA score may appear more practical due to its simpler and faster implementation, only the MPI demonstrated significant correlations with quality of life and nursing needs in the FU after 30 and 90 days.