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Charlson comorbidity index adjustment in intracerebral hemorrhage.

ABSTRACT: Previous studies of intracerebral hemorrhage (ICH) outcome prediction models have not systematically included adjustment for comorbid conditions. The purpose of this study was to assess whether the Charlson Comorbidity Index (CCI) was associated with early mortality and long-term functional outcome in patients with intracerebral hemorrhage.We performed a retrospective analysis on a prospective observational cohort of patients with ICH admitted to 2 University of California San Francisco hospitals from June 1, 2001 to May 31, 2004. Components of the ICH score and use of early care limitations were recorded. Outcome was assessed using the modified Rankin Scale to 12 months. The CCI was derived using hospital discharge International Classification of Diseases, revision 9 codes and patient history obtained from standardized case report forms.In this cohort of 243 ICH patients, comorbid conditions were common, with CCI scores ranging from 0 to 12. Only 29% of patients with high CCI scores (?3) achieved a 12-month modified Rankin Scale score of ?3 compared with 48% of patients with CCI scores of 0 (P=0.02). CCI score was independently predictive of 12-month functional outcome, with higher CCI having a greater impact (CCI=2: odds ratio, 2.3; P=0.06; CCI=?3: odds ratio, 3.5; P=0.001).Comorbid medical conditions as measured by the CCI independently influence outcome after ICH. Future ICH outcome studies should account for the impact of comorbidities on patient outcome.

SUBMITTER: Bar B

PROVIDER: S-EPMC3183144 | biostudies-literature | 2011 Oct

REPOSITORIES: biostudies-literature

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Charlson comorbidity index adjustment in intracerebral hemorrhage.

Bar Barak B Hemphill J Claude JC

Stroke 20110728 10

<h4>Background and purpose</h4>Previous studies of intracerebral hemorrhage (ICH) outcome prediction models have not systematically included adjustment for comorbid conditions. The purpose of this study was to assess whether the Charlson Comorbidity Index (CCI) was associated with early mortality and long-term functional outcome in patients with intracerebral hemorrhage.<h4>Methods</h4>We performed a retrospective analysis on a prospective observational cohort of patients with ICH admitted to 2 ...[more]

PMID: 21799172

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Project description:BackgroundThe original Charlson Comorbidity Index (CCI) encompassed 19 categories of medical conditions that were identifiable in medical records. Subsequent publications provided scoring algorithms based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The recent adoption of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes in the United States created a need for a new scoring scheme. In addition, a review of existing claims-based scoring systems suggested 3 areas for improvement: the lack of explicit identification of secondary diabetes, the lack of differentiation between HIV infection and AIDS, and insufficient guidance on scoring hierarchy. In addition, addressing the third need raised the issue of disease severity in renal disease.ObjectivesThis initiative aimed to create an expanded and refined ICD-9 scoring system for CCI, addressing the classification of issues noted above, create a corresponding ICD-10 system, assess the comparability of ICD-9- and ICD-10-based scores, and validate the new scoring scheme.MethodsWe created ICD-9 and ICD-10 code tables for 19 CCI medical conditions. The new scoring scheme was labeled CDMF CCI and was tested using claims-based data for individuals aged ≥65 years who participated in a Humana Medicare Advantage plan during at least 1 of 3 consecutive 12-month periods. Two 12-month periods were during the ICD-9 era and the third 12-month period was during the ICD-10 era. Because many individuals were counted in more than one 12-month period, we described the study population as comprising 3 panels. We used regression models to analyze the association between the CCI score and same-year inpatient admissions and near-term (90-day) mortality. Additional testing was done by comparing the mean CCI score or disease prevalence in the 3 subpopulations of people with HIV/AIDS, renal disease, or diabetes. Finally, we calculated area under the receiver operating characteristics (AUC-ROC) curve values by applying the Deyo system and our ICD-9 and ICD-10 scoring systems.ResultsThe CDMF ICD-9 and ICD-10 scoring scheme yielded comparable scores across the 3 panels, and inpatient admissions and mortality rates consistently increased in each panel as the CCI score increased. Comparisons of the performance of the Deyo system and our proposed CDMF ICD-9 system in the 3 key subpopulations showed that the CDMF ICD-9 system produced a lower CCI score in the presence of HIV infection without AIDS, achieved similar detection ability of diabetes, and allowed good differentiation between mild-to-moderate and severe renal disease. AUC-ROC values were similar between the CDMF ICD-9 coding system and the Deyo system.ConclusionOur results support the implementation of the CDMF CCI scoring instrument to triage individual patients for disease- and care-management programs. In addition, the CDMF scheme allows for a more precise understanding of chronic disease at a population level, thus allowing health systems and plans to design services and benefits to meet multifactorial clinical needs. Preliminary validation sets the stage for further testing using long-term follow-up data and for the adaptation of this coding scheme to a chart review instrument.

Project description:BackgroundIn the inpatient rehabilitation of older patients, estimating to what extent the patient may functionally recover (functional prognosis), is important to plan the rehabilitation programme and aid discharge planning. Comorbidity is very common in older patients. However, the role of comorbidity in making a functional prognosis is not clearly defined. The aim of this study was to investigate a modified and weighted Functional Comorbidity Index (w-FCI) in relation to functional recovery and compare its predictive performance with that of the Charlson comorbidity index (CCI) and the original Functional Comorbidity Index (FCI).MethodsThe COOPERATION study (Comorbidity and Outcomes of Older Patients Evaluated in RehabilitATION) is a prospective observational cohort study. Data of patients that were admitted in an inpatient geriatric rehabilitation facility in the UK between January and September 2017, were collected. The outcome measures were: the Elderly Mobility Scale (EMS) and Barthel index (BI) at discharge, EMS gain/day and BI gain/day. Baseline comorbidity was assessed using the CCI, the FCI and the w-FCI. Correlations, receiver operating curves (ROC), and multiple linear regression analyses were performed. The models were adjusted for age, gender and EMS or BI on admission.ResultsIn total, 98 patients (mean age 82 years; 37% male) were included. The areas under the ROC curves of the w-FCI (EMS at discharge: 0.72, EMS gain/day: 0.72, BI at discharge: 0.66 and BI gain/day: 0.60) were higher than for the CCI (0.50, 0.53, 0.49, 0.44 respectively) and FCI (0.65, 0.55, 0.60, 0.49 respectively). The w-FCI was independently associated with EMS at discharge (20.7% of variance explained (PVE), p < 0.001), EMS gain/day (11.2PVE, p < 0.001), and BI at discharge (18.3 PVE, p < 0.001). The FCI was only associated with EMS gain/day (3.9 PVE, p < 0.05). None of the comorbidity indices contributed significantly to BI gain/day (w-FCI: 2.4 PVE, p > 0.05).ConclusionsThe w-FCI was predictive of mobility & function at discharge and mobility gain per day, and outperformed the original FCI and the CCI. The w-FCI could be useful in assessing comorbidity in a personalised way and aid functional prognosis at the start of rehabilitation.

Project description:ObjectiveWith advances in medical diagnosis, more people are diagnosed with more than one disease. The damage caused by different diseases varies, so relying solely on the number of diseases to represent multimorbidity is limited. The Charlson comorbidity index (CCI) is widely used to measure multimorbidity and has been validated in various studies. However, CCI's demographic and behavioral risk factors still need more exploration.MethodsWe conduct multivariate logistic regression analysis and restricted cubic splines to examine the influence factors of CCI and the relationship between covariates and risk of CCI, respectively. Our research employs the Multivariate Imputation by Chained Equations method to interpolate missing values. In addition, the CCI score for each participant is calculated based on the inpatient's condition using the International Classification of Diseases, edition 10 (ICD10). Considering the differences in the disease burden between males and females, the research was finally subgroup analyzed by sex.ResultsThis study includes 5,02,411 participants (2,29,086 female) with CCI scores ranging from 0 to 98. All covariates differed between CCI groups. High waist-hip ratio (WHR) increases the risk of CCI in both males [OR = 19.439, 95% CI = (16.261, 23.241)] and females [OR = 12.575, 95% CI = (11.005, 14.370)], and the effect of WHR on CCI is more significant in males. Associations between age, Body Mass Index (BMI) and WHR, and CCI risk are J-shaped for all participants, males, and females. Concerning the association between Townsend deprivation index (TDI) and CCI risk, the U-shape was found in all participants and males and varied to a greater extent in males, but it is a J-shape in females.ConclusionsIncreased WHR, BMI, and TDI are significant predictors of poor health, and WHR showed a greater role. The impact of deprivation indices on health showed differences by sex. Socio-economic factors, such as income and TDI, are associated with CCI. The association of social status differences caused by these socioeconomic factors with health conditions should be considered. Factors might interact with each other; therefore, a comprehensive, rational, and robust intervention will be necessary for health.

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Charlson comorbidity index adjustment in intracerebral hemorrhage.

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Charlson comorbidity index adjustment in intracerebral hemorrhage.

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