Can the Multidimensional Prognostic Index Improve the Identification of Older Hospitalized Patients with COVID-19 Likely to Benefit from Mechanical Ventilation? An Observational, Prospective, Multicenter Study.
Alberto Pilotto, Eva Topinkova, Helena Michalkova and 14 others
PMID 35934019WHAT IT FOUND
In older hospitalized patients with COVID-19, mechanical ventilation was associated with higher risk of death and rehospitalization only in those with a Multidimensional Prognostic Index score above 0.50.
Adding this frailty index to oxygenation measures improved prediction of these outcomes.
Key findings
01Mechanical ventilation was associated with a higher risk of negative outcomes, rehospitalization, and mortality, but only in patients with an MPI score greater than 0.50.
02No significant association was found between mechanical ventilation and negative outcomes in patients with an MPI score less than 0.50.
03Adding the MPI score to a model containing age, sex, and the PaO2/FiO2 ratio significantly improved the accuracy of predicting death or rehospitalization.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The observational design introduces potential selection bias. The study could not separate the effects of non-invasive ventilation from orotracheal intubation. The MPI was not compared against other frailty indices due to lack of data.
The easy way to misread this
Do not conclude that mechanical ventilation causes harm in frail patients. The study shows an association, but the frailty itself (MPI > 0.50) is a strong predictor of poor outcomes. The ventilation was likely given to the sickest patients, and the study did not randomize treatment.