Charlson Comorbidity Index
In medicine, the Charlson Comorbidity Index (CCI) predicts the mortality for a patient who may have a range of concurrent conditions (comorbidities), such as heart disease, AIDS, or cancer (considering a total of 17 categories).[1] A score of zero means that no comorbidities were found; the higher the score, the higher the predicted mortality rate is.[2][3] For a physician, this score is helpful in deciding how aggressively to treat a condition.
It is one of the most widely used scoring system for comorbidities.[4] The index was developed by Mary Charlson and colleagues in 1987, but the methodology has been adapted several times since then based on the findings of additional studies.[5] Many variations of the Charlson comorbidity index have been presented, including the Charlson/Deyo, Charlson/Romano, Charlson/Manitoba, and Charlson/D'Hoores comorbidity indices.
Calculation
Each condition is assigned a score of 1, 2, 3, or 6, depending on the risk of dying associated with each one. Clinical conditions and associated scores are as follows:
- 1 each: Myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, rheumatologic disease, peptic ulcer disease, liver disease (if mild, or 3 if moderate/severe), diabetes (if controlled, or 2 if uncontrolled)
- 2 each: Hemiplegia or paraplegia, renal disease, malignancy (if localized, or 6 if metastatic tumor), leukemia, lymphoma
- 6 each: AIDS
. Patients who are 50 years old or more get additional points:[6]
- 50-59 years old: +1 point
- 60-69 years old: +2 points
- 70-79 years old: +3 points
- 80 years old or more: +4 points
Scores are summed to provide a total score to predict mortality.
Currently 17 categories are considered in the popular Charlson/Deyo variant,[7] instead of 19 in the original score.[8] The weights were also adapted in 2003.[9]
Conditions can be identified using the International Classification of Diseases (ICD) diagnosis codes commonly used in patient records.
Use
For a physician, this score is helpful in deciding how aggressively to treat a condition. For example, a patient may have cancer with comorbid heart disease and diabetes. These comorbidities may be so severe that the costs and risks of cancer treatment would outweigh its short-term benefit.
Since patients often do not know how severe their conditions are, nurses were originally supposed to review a patient's chart and determine whether a particular condition was present in order to calculate the index. Subsequent studies have adapted the comorbidity index into a questionnaire for patients.
The Charlson index, especially the Charlson/Deyo, followed by the Elixhauser have been most commonly referred by the comparative studies of comorbidity and multimorbidity measures.[10]
References
- Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987). "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation". Journal of Chronic Diseases. 40 (5): 373–383. doi:10.1016/0021-9681(87)90171-8. PMID 3558716.
- Charlson ME, Carrozzino D, Guidi J, Patierno C (2022). "Charlson Comorbidity Index: A Critical Review of Clinimetric Properties". Psychotherapy and Psychosomatics. 91 (1): 8–35. doi:10.1159/000521288. hdl:11585/857954. PMID 34991091. S2CID 245802035.
- Kim S, Park J, Kwon JH, Oh AR, Gook J, Yang K, et al. (September 2021). "The Charlson Comorbidity Index is associated with risk of 30-day mortality in patients with myocardial injury after non-cardiac surgery". Scientific Reports. 11 (1): 18933. Bibcode:2021NatSR..1118933K. doi:10.1038/s41598-021-98026-4. PMC 8460655. PMID 34556689.
- Figueiredo S (3 March 2009). Zeltzer L, Korner-Bitensky N, Sitcoff E (eds.). "Charlson Comorbidity Index (CCI) – Strokengine". Retrieved 2023-03-25.
- "Concept: Charlson Comorbidity Index". mchp-appserv.cpe.umanitoba.ca. Retrieved 2023-03-25.
- Gong G, Wan W, Zhang X, Liu Y, Liu X, Yin J (December 2019). "Correlation between the Charlson comorbidity index and skeletal muscle mass/physical performance in hospitalized older people potentially suffering from sarcopenia". BMC Geriatrics. 19 (1): 367. doi:10.1186/s12877-019-1395-5. PMC 6929451. PMID 31870318.
- Deyo RA, Cherkin DC, Ciol MA (June 1992). "Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases". Journal of Clinical Epidemiology. 45 (6): 613–619. doi:10.1016/0895-4356(92)90133-8. PMID 1607900.
- "Charlson Comorbidity Index Calculator". www.omnicalculator.com. Retrieved 2023-03-25.
- Schneeweiss S, Wang PS, Avorn J, Glynn RJ (August 2003). "Improved comorbidity adjustment for predicting mortality in Medicare populations". Health Services Research. 38 (4): 1103–1120. doi:10.1111/1475-6773.00165. PMC 1360935. PMID 12968819.
- Sharabiani MT, Aylin P, Bottle A (December 2012). "Systematic review of comorbidity indices for administrative data". Medical Care. 50 (12): 1109–1118. doi:10.1097/MLR.0b013e31825f64d0. PMID 22929993. S2CID 25852524.