Charlson Comorbidity Index in Ischemic Stroke and Intracerebral Hemorrhage as Predictor of Mortality and Functional Outcome after 6 Months

Caballero, Pedro Enrique Jiménez; Espuela, Fidel López; Portilla-Cuenca, Juan Carlos; Moreno, Juan Mozas; Zamorano, Juan Diego Pedrera; Naranjo, I. Casado

doi:10.1016/j.jstrokecerebrovasdis.2012.11.014

Cited by 94 publications

(65 citation statements)

References 20 publications

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“…Overall differences in terms of mortality risk magnitude verified across studies compared to ours could be explained because EMMA participants had much higher frequencies of traditional CVRF than other previous studies that evaluated the prognostic value of CCI [11,12,13,14,16,18,19]. Moreover, in our cohort, we observed a situation that often occurs in low-income Brazilian population; half the number of participants who had IS were not taking anti-hypertensives and less than 20% was under lipid-lowering and diabetes medications that could contribute to some complications such as CHD, chronic kidney disease, and systolic heart failure.…”

Section: Discussioncontrasting

confidence: 47%

“…Other cohorts also evaluated the CCI in other different scenarios involving young individuals, with short follow-up and including hemorrhagic cases; they still found increased CCI associated to high mortality risk [18,19]. …”

Section: Discussionmentioning

confidence: 99%

“…In this context, the Charlson Comorbidity Index (CCI) [13] is one of the most often used comorbidity score employed in longitudinal studies to evaluate prognosis [11,12,14,15,16,17,18,19,20]. A modified version of Charlson index was adapted by Goldstein et al [14] for predicting functionality at hospital discharge and 1-year mortality in ischaemic stroke (IS) patients.…”

Section: Introductionmentioning

confidence: 99%

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Multimorbidities Are Associated to Lower Survival in Ischaemic Stroke: Results from a Brazilian Stroke Cohort (EMMA Study)

Castro¹,

Alencar²,

Benseñor³

et al. 2017

Cerebrovasc Dis

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Background: Stroke prognosis is related to the multimorbidity profile. Moreover, performing an individual evaluation of most common cerebrovascular risk factors (CVRF) not always identifies patients with poor prognosis. Thus, we decided to evaluate multimorbidity profile, focusing on the Charlson Comorbidity Index (CCI) validated by Goldstein for ischaemic stroke (IS) patients, a score that measures a burden of comorbidities and its related mortality in the long-term survival of the EMMA Study (Study of Stroke Mortality and Morbidity). Methods: Nine hundred fifty-nine individuals (median age 70 years) had validated data on the diagnosis of IS, main CVRF and clinical comorbidities pre index event such as atrial fibrillation (AF), stroke recurrence, diabetes, hypertension, heart failure and cancer. CCI modified by Goldstein was calculated, which includes 17 clinical conditions with scores ranging from 1 to 6 (0-31 points). Survival analyses were performed by Kaplan-Meier curves and Cox logistic regression models (cumulative hazard ratio [HR] with [95% CI]) for all-cause mortality at 180 days, and every 3 years up to 9-year follow-up. Mortality analyzes were performed by CCI categorized according to weight added to comorbidities (Reference group: zero, moderate: 1, severe: 2 and very severe: ≥3 points). We also tested the modification effect of AF and stroke recurrence including these conditions in the CCI. Results: The overall survival rate was 47% (508 deaths/959). The worst survival (577, 95% CI 381-773 days) and the highest risk of death after stroke were observed in the very severe CCI group (HR 3.18; 95% CI 2.16-4.69) up to 9 years. The inclusion of previous AF and stroke in the CCI slightly increased the risk of death for very severe CCI (HR 3.27; 95% CI 2.07-5.18). Conclusions: A high burden of comorbidities represented an independent predictor of poor prognosis increasing the risk of dying by 2 to 3 times among IS up to 9 years in the EMMA study. The inclusion of other CVRF such as AF and stroke recurrence slightly modified all-cause mortality risk.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multimorbidities Are Associated to Lower Survival in Ischaemic Stroke: Results from a Brazilian Stroke Cohort (EMMA Study)

Castro¹,

Alencar²,

Benseñor³

et al. 2017

Cerebrovasc Dis

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“…Components of the Charlson comorbidity score (CCS) until inclusion date was retrieved, and an individual comorbidity score was created. The CCS has been validated to some extent for prediction of outcome after stroke (15). The ICD coding of CCS in the National Patient Registry has been validated (16).…”

Section: Comorbiditymentioning

confidence: 99%

Radioiodine therapy increases the risk of cerebrovascular events in hyperthyroid and euthyroid patients

Cour

Jensen

Vej-Hansen

et al. 2015

European Journal of Endocrinology

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Background and objective: Hyperthyroid patients treated with radioiodine have increased morbidity and mortality from cerebrovascular events. This risk has until now has been attributed to the hyperthyroidism. However, radioiodine therapy of benign thyroid diseases exposes the carotid arteries to radiation and is capable of inducing atherosclerosis. The objective of the study was to elucidate whether ionizing radiation from radioiodine might contribute to cerebrovascular morbidity. Methods: In a retrospective register cohort study, 4000 hyperthyroid and 1022 euthyroid goitre patients treated with radioiodine between 1975 and 2008 were matched 1:4 on age and sex with random controls. The cohort was followed from the date of treatment until hospitalization due to cerebrovascular event, death, 20 years of follow-up or March 2013. Data were analyzed in competing risk models adjusting for age, sex, Charlson's comorbidity score, atrial fibrillation and previous cerebrovascular events. Results: Mean follow-up time was 11.5 years, mean age 61 years, with a total number of 3228 events. Comparing all radioiodine-treated patients with controls, the fully adjusted model showed increased risk of cerebrovascular events among all treated patients, hazard ratio (HR) 1.18 (95% CI 1.09-1.29). The risk was increased among hyperthyroid (HR 1.17; 95% CI 1.07-1.28) as well as euthyroid patients (HR 1.21; 95% CI 1.02-1.44). Conclusions: We report an increased risk of cerebrovascular events in hyperthyroid as well as euthyroid patients treated with radioiodine for benign thyroid disorders. That these patient groups have similar risks suggests the possibility that radiation from radioiodine contributes to cerebrovascular morbidity via acceleration or initiation of atherosclerosis.

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“…3M™ all patient refined diagnosis-related groups (APR-DRGs)-based risk of mortality subclass, a validated proprietary risk-adjustment algorithm [3], and Charlson comorbidity index [4] were used for case severity adjustment.…”

Section: Methodsmentioning

confidence: 99%

Trends in Inpatient Mortality After Ischemic and Hemorrhagic Strokes in the United States

Moradiya¹,

Murthy²,

Luis³

et al. 2014

Neuroepidemiology

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Charlson Comorbidity Index in Ischemic Stroke and Intracerebral Hemorrhage as Predictor of Mortality and Functional Outcome after 6 Months

Cited by 94 publications

References 20 publications

Multimorbidities Are Associated to Lower Survival in Ischaemic Stroke: Results from a Brazilian Stroke Cohort (EMMA Study)

Multimorbidities Are Associated to Lower Survival in Ischaemic Stroke: Results from a Brazilian Stroke Cohort (EMMA Study)

Radioiodine therapy increases the risk of cerebrovascular events in hyperthyroid and euthyroid patients

Trends in Inpatient Mortality After Ischemic and Hemorrhagic Strokes in the United States

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