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The multidimensional prognostic index (MPI) predicts long-term mortality in old type 2 diabetes mellitus patients: a
F Salis1, E Cossu2, A Mandas3,2
1Department of Medical Sciences, and Public Health, University of Cagliari, SS 554 bivio Sestu, 09042, Monserrato, Cagliari, Italy. francesco-salis@tiscali.it.
Purpose:
The Multidimensional Prognostic Index (MPI) is a tool capable of holistically frame older patients in different settings and affected by different pathologies, establishing a risk of adverse events. Among them, type 2 diabetes mellitus (T2DM), a common metabolic disease in the elderly, is responsible for complications and deaths. Few previous works have focused specifically on MPI and DM, and none have followed up the patients for more than 3 years. The aim of the present study is to analyze MPI accuracy in predicting mortality in a cohort of T2DM patients followed-up for 13 years.
Methods:
The enrolled subjects were evaluated with MPI, identifying three levels of risk: MPI1 (low risk, 0.0-0.33), MPI2 (moderate risk, 0.34-0.66), and MPI3 (severe risk, 0.67-1.0), and with glycated hemoglobin, and years since T2DM diagnosis.
Results:
One hundred and seven patients met the inclusion criteria. MPI3 was excluded by further analysis since it was made up of only three patients. Overall, cognitive performances, autonomies in daily living, nutritional status, risk of pressure injuries, comorbidities, and taken drugs were better (p ≤ 0.0077) in MPI1 than MPI2; moreover, the story of T2DM was shorter (p = 0.0026). Cox model showed an overall 13-year survival of 51.9%, and survival rates were significantly smaller in MPI2 (HR: 4.71, p = 0.0007). Finally, increased age (HR: 1.15), poorer cognitive abilities (HR: 1.26), vascular (HR: 2.15), and kidney (HR: 2.17) diseases were independently associated with death.
Conclusion:
Our results prove that MPI predicts short-, mid-, and even long-term mortality in T2DM patients, whose death seems to be related to age and cognitive status, and even more to vascular and kidney diseases.
Insights
The Multidimensional Prognostic Index (MPI) accurately predicts mortality in type 2 diabetes mellitus (T2DM) patients over 13 years. Higher MPI scores indicate increased mortality risk, highlighting its utility in managing T2DM complications.
Area of Science:
- Gerontology
- Endocrinology
- Biostatistics
Background:
- Type 2 diabetes mellitus (T2DM) is a prevalent metabolic disease in older adults, associated with significant morbidity and mortality.
- The Multidimensional Prognostic Index (MPI) is a validated tool for assessing adverse event risk in elderly patients across various clinical settings.
- Limited research has specifically investigated the long-term prognostic accuracy of MPI in T2DM populations.
Purpose of the Study:
- To evaluate the accuracy of the Multidimensional Prognostic Index (MPI) in predicting long-term mortality among patients with type 2 diabetes mellitus (T2DM).
- To assess the MPI's performance in a cohort of T2DM patients over a 13-year follow-up period.
Main Methods:
- A cohort of 107 T2DM patients was assessed using the MPI, categorizing them into low (MPI1) and moderate (MPI2) risk groups.
- Data collected included glycated hemoglobin levels and duration of T2DM diagnosis.
- Survival analysis, including Cox proportional hazards models, was employed to determine mortality predictors over 13 years.
Main Results:
- Patients in the moderate-risk MPI2 group exhibited significantly lower survival rates compared to the low-risk MPI1 group (HR: 4.71, p=0.0007).
- Overall 13-year survival was 51.9%.
- Independent predictors of mortality included increased age, poorer cognitive function, and the presence of vascular and kidney diseases.
Conclusions:
- The MPI is a reliable tool for predicting short-, mid-, and long-term mortality in T2DM patients.
- Mortality risk in this cohort is associated with advancing age, cognitive status, and particularly with vascular and kidney diseases.
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