Charlson Comorbidity Index: A Critical Review of Clinimetric Properties

Abstract

The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient’s unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.

Comorbidity: From a Confounder in Longitudinal Clinical Research to the Main Issue in Population Management

“…If not targeted on the highest risk patients, the intervention will cost more than it will save, because increased resources will be devoted to lower risk patients who do not need them [78,87]. Using the Charlson comorbidity index, depending on the specific population and the criteria, can identify between 6 and 20% of adults have prognostically significant multiple chronic diseases [88,89]. This is the challenge of comorbidity in this decade.…”

Disease-Modifying Drugs for Multiple Sclerosis and Association With Survival

“… 1 The very small event rates by various specific causes of death would also have hindered the generation of reliable estimates. 9 The Charlson Comorbidity Index is an assessment tool designed to predict long-term mortality, 46 and we used this in our study to measure, and adjust for, comorbidity burden. This comorbidity index includes significant comorbidities that are associated with survival, such as congestive heart failure, myocardial infarction, diabetes, and vascular disease (peripheral and cerebrovascular).…”

Development and Validation of a Nomogram for Adverse Outcomes of Geriatric Trauma Patients Based on Frailty Syndrome

“…The clinical sensitivity of aCCI has been demonstrated in a variety of medical conditions, and progressive increases in CCI have been associated with progressive increases in mortality. 12 Massive blood transfusions have been reported to be associated with a variety of complications, and BT units are important in determining the probability of death. 13 Prealbumin and lactate have also been reported to be strongly associated with the prognosis of elderly trauma patients.…”