Charlson comorbidity index as a predictor of in-hospital death in acute ischemic stroke among very old patients: a single-cohort perspective study

Abstract

Chronic diseases are increasing worldwide. Association of two or more chronic conditions is related with poor health status and reduced life expectancy, particularly among elderly patients. Comorbidities represent a risk factor for adverse events in several critical illnesses. We aimed to evaluate if elderly patients are affected by multiple chronic pathologies, assessed by Charlson comorbidity index (CCI), showed a reduced in-hospital survival after ischemic stroke. In a 3-year period, we evaluated all the subjects admitted to our internal medicine department for ischemic stroke. Age, sex, NIHSS score and all the comorbidities were recorded. Days of hospitalization, hospital-related infections and in-hospital mortality were also assessed. For each patient, we evaluated CCI, obtaining four classes: group 1 (CCI: 2-3), group 2 (CCI: 4-5), group 3 (CCI: 6-7) and group 4 (CCI: ≥8). Survival was evaluated with Kaplan-Meier and Cox regression analyses. The complete model considered in-hospital death as the main outcome, days of hospitalization as the time variable and CCI as the main predictor, adjusting for NIHSS, sex and nosocomial infections. Patients in CCI group 3 and 4 had an increased risk of in-hospital mortality, independently of NIHSS, sex and nosocomial infections. Elderly patients with multiple comorbidities have higher risk of in-hospital death when affected by ischemic stroke.

Serum uric acid, kidney function and acute ischemic stroke outcomes in elderly patients: a single-cohort, perspective study

“…Hyperuricemic patients, however, have an increased prevalence of specific conditions, such as older age, 24 poorly controlled hypertension, 8 HF, 18 CKD, 25 metabolic syndrome, 6 CVD, 7 NVAF, 9 and multimorbidity, 22 which are potentially involved in increasing stroke risk and negatively influencing stroke outcome. For this reason, the role of SUA as an independent risk factor for an unfavourable outcome in stroke patients is still widely controversial.…”

“…We adjusted the model for the most common medical conditions observed in elderly patients associated to a worse IS outcome: sex, 15 age, 15 NIHSS at the admission, 15 hypertension, 16 diabetes, 15,17 HF, 18 NVAF, 15,19 dyslipidaemia, 19 cancer, 20 COPD, 21 multimorbidity, 22 hospital-acquired infections and dementia. 23 …”

Geographic Variations in In‐Hospital Mortality and Use of Percutaneous Coronary Intervention Following Acute Myocardial Infarction in China: A Nationwide Cross‐Sectional Analysis

“…AMI was categorized into 2 subtypes by existing ST‐segment elevation: STEMI, identified by ICD‐10 codes I21.0 to 3, I21.9, I22.0 to 1, and I22.8 to 9; and non‐STEMI (NSTEMI), identified by ICD‐10 codes I21.4 and I22.2 40. We also calculated each patient's Charlson Comorbidity Index (CCI)41 using the adaptation to predict in‐hospital or short‐term mortality 42, 43, 44, 45. This comorbidity index is based on the presence or absence of 17 different conditions during the primary (index) hospitalization, including disorders such as renal disease, liver disease, pulmonary disease, diabetes mellitus, peripheral arterial disease, and cancer.…”

“…40 We also calculated each patient's Charlson Comorbidity Index (CCI) 41 using the adaptation to predict inhospital or short-term mortality. [42][43][44][45] This comorbidity index is based on the presence or absence of 17 different conditions during the primary (index) hospitalization, including disorders such as renal disease, liver disease, pulmonary disease, diabetes mellitus, peripheral arterial disease, and cancer. Clinical conditions included in the CCI system were identified using ICD-10 codes in any secondary diagnosis field.…”

Charlson comorbidity index applied to Internal Medicine patients: a multicenter study

“…El índice de comorbilidad de Charlson es un instrumento que predice las complicaciones de la (3,12,14) suma de ciertas enfermedades, como la capacidad funcional al alta y la mortalidad . Esta correlación entre el índice de Charlson y la mortalidad se ha demostrado en diferentes patologías: (15,17) accidente vascular cerebral isquémico o hemorrágico , enfermedad pulmonar obstructiva (18)…”