Charlson Comorbidity Index
{{Short description|Medical index to predict mortality}}
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).{{cite journal | vauthors = Charlson ME, Pompei P, Ales KL, MacKenzie CR | title = A new method of classifying prognostic comorbidity in longitudinal studies: development and validation | journal = Journal of Chronic Diseases | volume = 40 | issue = 5 | pages = 373–383 | year = 1987 | pmid = 3558716 | doi = 10.1016/0021-9681(87)90171-8 }} A score of zero means that no comorbidities were found; the higher the score, the higher the predicted mortality rate and the lower the predicted ten-year survival.{{cite journal | vauthors = Charlson ME, Carrozzino D, Guidi J, Patierno C | title = Charlson Comorbidity Index: A Critical Review of Clinimetric Properties | language = english | journal = Psychotherapy and Psychosomatics | volume = 91 | issue = 1 | pages = 8–35 | date = 2022 | pmid = 34991091 | doi = 10.1159/000521288 | s2cid = 245802035 | hdl = 11585/857954 | hdl-access = free }}{{cite journal | vauthors = Kim S, Park J, Kwon JH, Oh AR, Gook J, Yang K, Choi JH, Kim K, Sung JD, Ahn J, Lee SH | display-authors = 6 | title = The Charlson Comorbidity Index is associated with risk of 30-day mortality in patients with myocardial injury after non-cardiac surgery | journal = Scientific Reports | volume = 11 | issue = 1 | pages = 18933 | date = September 2021 | pmid = 34556689 | doi = 10.1038/s41598-021-98026-4 | pmc = 8460655 | bibcode = 2021NatSR..1118933K }} 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.{{Cite web | vauthors = Figueiredo S | date = 3 March 2009 | veditors = Zeltzer L, Korner-Bitensky N, Sitcoff E |title=Charlson Comorbidity Index (CCI) – Strokengine |url=https://strokengine.ca/en/assessments/charlson-comorbidity-index-cci/ |access-date=2023-03-25 |language=en-US}} 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.{{Cite web |title=Concept: Charlson Comorbidity Index |url=http://mchp-appserv.cpe.umanitoba.ca/viewConcept.php?printer=Y&conceptID=1098 |access-date=2023-03-25 |website=mchp-appserv.cpe.umanitoba.ca}} 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:{{cite journal | vauthors = Gong G, Wan W, Zhang X, Liu Y, Liu X, Yin J | title = Correlation between the Charlson comorbidity index and skeletal muscle mass/physical performance in hospitalized older people potentially suffering from sarcopenia | journal = BMC Geriatrics | volume = 19 | issue = 1 | pages = 367 | date = December 2019 | pmid = 31870318 | pmc = 6929451 | doi = 10.1186/s12877-019-1395-5 | doi-access = free }}
- 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,{{cite journal | vauthors = Deyo RA, Cherkin DC, Ciol MA | title = Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases | journal = Journal of Clinical Epidemiology | volume = 45 | issue = 6 | pages = 613–619 | date = June 1992 | pmid = 1607900 | doi = 10.1016/0895-4356(92)90133-8 }} instead of 19 in the original score.{{Cite web |title=Charlson Comorbidity Index Calculator |url=https://www.omnicalculator.com/health/cci |access-date=2023-03-25 |website=www.omnicalculator.com |language=en}} The weights were also adapted in 2003.{{cite journal | vauthors = Schneeweiss S, Wang PS, Avorn J, Glynn RJ | title = Improved comorbidity adjustment for predicting mortality in Medicare populations | journal = Health Services Research | volume = 38 | issue = 4 | pages = 1103–1120 | date = August 2003 | pmid = 12968819 | pmc = 1360935 | doi = 10.1111/1475-6773.00165 }}
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.{{cite journal | vauthors = Sharabiani MT, Aylin P, Bottle A | title = Systematic review of comorbidity indices for administrative data | journal = Medical Care | volume = 50 | issue = 12 | pages = 1109–1118 | date = December 2012 | pmid = 22929993 | doi = 10.1097/MLR.0b013e31825f64d0 | s2cid = 25852524 }}