Age‑adjusted Charlson comorbidity index and in‑hospital mortality in critically ill patients with cardiogenic shock: A retrospective cohort study

Abstract

Evidence regarding the relationship between age-adjusted Charlson comorbidity index (ACCI) and in-hospital mortality is limited. Therefore, the present study investigated whether there was an independent association between ACCI and in-hospital mortality in critically ill patients with cardiogenic shock (CS) after adjusting for other covariates (age, sex, history of disease, scoring system, in-hospital management, vital signs at presentation, laboratory findings and vasopressors). ACCI, calculated retrospectively after hospitalization between 2008 and 2019, was derived from intensive care unit (ICU) admissions at the Beth Israel Deaconess Medical Center (Boston, MA, USA). Patients with CS were classified into two categories based on predefined ACCI scores (low, <8; high, ≥8). Based on baseline ACCI, the risk of in-hospital mortality in patients with CS was calculated using a multivariate Cox proportional risk model, and the threshold effect was calculated using a two-piece linear regression model. The in-hospital mortality rate was ~1.5 times greater in the ACCI high group compared with that in the ACCI low group [hazard ratio (HR)=1.45; 95% confidence interval (CI), 1.14 - 1.86]. Additional analysis showed that ACCI had a curvilinear association with in-hospital mortality risk in patients with CS, with a saturation effect predicted at 4.5. When ACCI was >4.5, the risk of in-hospital CS death increased significantly with increasing ACCI (HR=1.122; 95% CI, 1.054 - 1.194). Overall, ACCI was an independent predictor of in-hospital mortality in ICU patients with CS. A non-linear relationship was revealed between ACCI and in-hospital mortality, where in-hospital mortality increased significantly when ACCI was >4.5.

Las decisiones difíciles en tiempos complejos deben tomarse con prudencia

“…El ICC se utiliza para ayudar en la evaluación pronóstica, en la estratificación del riesgo y en la toma de decisiones clínicas, y puede aplicarse en diversas áreas de la medicina, como la oncología, la cardiología, la nefrología y la geriatría 51 . Ha sido especialmente útil para predecir el riesgo de mortalidad a largo plazo en diferentes poblaciones, como pacientes clínicos, quirúrgicos, víctimas de traumatismos y en contexto intrahospitalario, incluida la UCI, ayudando a los médicos a personalizar el tratamiento y tomar decisiones informadas sobre los cuidados de salud [51][52][53][54] .…”

Hard choices during complex times require wisdom

“…The CCI is used to assist in prognostic assessment, risk stratification and clinical decision-making, and can be used in several areas of medicine, such as oncology, cardiology, nephrology and geriatrics 51 . It has been especially useful for predicting long-term risk of mortality in different populations, such as clinical and surgical patients and trauma victims, and in intra-hospital care, including ICU, helping physicians personalize treatment and make informed decisions about health care [51][52][53][54] .…”

Escolhas difíceis em tempos complexos devem ser feitas com sabedoria

“…O ICC é usado para auxiliar na avaliação prognóstica, na estratificação de risco e na tomada de decisões clínicas, podendo ser aplicado em diversas áreas da medicina, como oncologia, cardiologia, nefrologia e geriatria 51 . Tem sido especialmente útil para prever o risco de mortalidade em longo prazo em diferentes populações, como pacientes clínicos, cirúrgicos, vítimas de traumatismo e em contexto intra-hospitalar, inclusive de UTI, ajudando médicos a personalizar tratamento e tomar decisões informadas sobre os cuidados de saúde [51][52][53][54] .…”