Predicting mortality from change-over-time in the Charlson Comorbidity Index

Fraccaro, Paolo; Kontopantelis, Evangelos; Sperrin, Matthew; Peek, Niels; Mallen, Christian; Urban, Philip; Buchan, Iain; Mamas, Mamas A.

doi:10.1097/md.0000000000004973

Cited by 66 publications

(32 citation statements)

References 45 publications

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“…Therefore, to preclude underlying comorbidities from interfering with our results, we excluded the subjects who died within 1 year after follow-up and adjusted for the CCI. The CCI, which was developed in 1987 [ 30 ], successfully captures the effect of comorbidity burden on mortality [ 31 ]. In the present study, after adjusting for baseline CCI, although it was just scored as 0 or 1, the positive association between increased WC and mortality remained significant.…”

Section: Discussionmentioning

confidence: 99%

Differential relationship between waist circumference and mortality according to age, sex, and body mass index in Koreans with age of 30–90 years; a nationwide health insurance database study

Cho

Yoo

Hwang

et al. 2018

BMC Med

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BackgroundA recent concept is that obesity, assessed by body mass index (BMI), is not always a sign of poor health. Thus, in order to use obesity metrics in clinical decision making, it is important to clarify the relationship between waist circumference (WC), a proxy for abdominal obesity, and mortality.MethodsData were used from 8,796,759 subjects aged between 30 and 90 years, who had participated in the Korea National Health Screening Examination between January 1, 2009 and December 31, 2009 and survived at least 1 year post screening. Data from a mean follow-up time of an additional 5.3 years (time at risk) were analyzed for the relationship between WC and mortality according to age, sex, and BMI category.ResultsAn increased WC of more than 90 cm in men and 85 cm in women showed a definite negative influence on mortality. However, the detailed relationship between WC and mortality was J-shaped or U-shaped according to age, sex, and BMI category. In the normal BMI group, the optimal WC range with the lowest mortality was < 70 cm in men and 70–75 cm in women, whereas in obese individuals a WC between 80 and 90 cm in men and 75 and 85 cm in women showed the lowest mortality. The association between increased WC and higher mortality tended to be more obvious in normal-weight women than in normal-weight men or obese women. Furthermore, in normal-weight and obese women, the effect of increased WC on mortality was more critical for subjects aged < 60 years rather than those aged ≥ 60 years.ConclusionsAbdominal obesity, as measured by WC, showed a significant negative association on mortality, and its association with mortality was different according to age, sex, and BMI category. Therefore, WC should be considered in the assessment of obesity-related health risks, and individualized cut-off points for the definition of a healthy WC according to age, sex, and BMI category are necessary.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1114-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Differential relationship between waist circumference and mortality according to age, sex, and body mass index in Koreans with age of 30–90 years; a nationwide health insurance database study

Cho

Yoo

Hwang

et al. 2018

BMC Med

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“… 23 Recent studies with large samples in the United States and United Kingdom have demonstrated that a change in CCI over time may be a better predictor of long-term mortality than a single baseline measurement as done here. 24 , 25 There are also efforts to improve the predictive power of CCI by refining it or using it in a combinatorial scoring system that incorporates the Elixhauser system. 23 In this study, patients with SCI were younger, had higher ISS scores, greater hospital lengths of stay, and greater number of days on a ventilator ( Figure 3 ).…”

Section: Discussionmentioning

confidence: 99%

Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture

Bank

Gibbs

Sison

et al. 2018

Geriatr Orthop Surg Rehabil

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Objective:To identify clinical or demographic variables that influence long-term mortality, as well as in-hospital mortality, with a particular focus on the effects of age.Summary and Background Data:Cervical spine fractures with or without spinal cord injury (SCI) disproportionately impact the elderly who constitute an increasing percentage of the US population.Methods:We analyzed data collected for 10 years at a state-designated level I trauma center to identify variables that influenced in-hospital and long-term mortality among elderly patients with traumatic cervical spine fracture with or without SCI. Acute in-hospital mortality was determined from hospital records and long-term mortality within the study period (2003-2013) was determined from the National Death Index. Univariate and multivariate regression analyses were used to identify factors influencing survival.Results:Data from patients (N = 632) with cervical spine fractures were analyzed, the majority (66%) of whom were geriatric (older than age 64). Most patients (62%) had a mild/moderate injury severity score (ISS; median, interquartile range: 6, 5). Patients with SCI had significantly longer lengths of stay (14.1 days), days on a ventilator (3.5 days), and higher ISS (14.9) than patients without SCI (P < .0001 for all). Falls were the leading mechanism of injury for patients older than age 64. Univariate analysis identified that long-term survival decreased significantly for all patients older than age 65 (hazard ratio [HR]: 1.07; P < .0001). Multivariate analysis demonstrated age (HR: 1.08; P < .0001), gender (HR: 1.60; P < .0007), and SCI status (HR: 1.45, P < .02) significantly influenced survival during the study period.Conclusion:This study identified age, gender, and SCI status as significant variables for this study population influencing long-term survival among patients with cervical spine fractures. Our results support the growing notion that cervical spine injuries in geriatric patients with trauma may warrant additional research.

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“…QTc prolongation was defined as a value greater than 460 ms for men and 470 ms for women [ 1 ]. Demographic and clinical data was collected from all patients, including cause of admission, co-morbidities, vital signs, blood biochemistry, arterial gasometry, Glasgow [ 15 ], SAPS II [ 16 ] and SOFA scores [ 17 ], and the Charlson Comorbidity Index [ 18 ]. All medications administered to the patient in the 24 hours prior to ICU admission were recorded.…”

Section: Methodsmentioning

confidence: 99%

QTc interval prolongation in critically ill patients: Prevalence, risk factors and associated medications

et al. 2018

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PurposeTo investigate the prevalence and risk factors of acquired long QT syndrome (LQTS) on admission to a general Intensive Care Unit (ICU), and to assess the risk of LQTS associated with prescribed medications.MethodsProspective observational, cross-sectional study approved by the Institutional Review Board. Between May 2014 and July 2016, 412 patients >18 years-old consecutively admitted to the ICU of a university hospital were included. LQTS was defined as a QT interval on the admission electrocardiogram corrected using Bazett’s formula (QTc) >460 ms for men and >470 ms for women. All medications administered within 24 hours before admission were recorded. Logistic regression was used.ResultsLQTS prevalence was 27.9%. In LQTS patients, 70.4% had ≥ 1 LQTS-inducing drug prescribed in the 24 hours prior to ICU admission versus 70.4% in non-LQTS patients (p = 0.99). Bradycardia and Charlson morbidity index score are independent risk factors for LQTS. Haloperidol (OR 4.416), amiodarone (OR 2.509) and furosemide (OR 1.895) were associated with LQTS, as well as another drug not yet described, namely clopidogrel (OR 2.241).ConclusionsThe LQTS is highly prevalent in critically ill patients, ICU patients are often admitted with LQTS-inducing medications, and patients with slow heart rate or with high Charlson comorbidity index should be evaluated for LQTS.

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Predicting mortality from change-over-time in the Charlson Comorbidity Index

Abstract: Supplemental Digital Content is available in the text

Cited by 66 publications

References 45 publications

Differential relationship between waist circumference and mortality according to age, sex, and body mass index in Koreans with age of 30–90 years; a nationwide health insurance database study

Differential relationship between waist circumference and mortality according to age, sex, and body mass index in Koreans with age of 30–90 years; a nationwide health insurance database study

Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture

QTc interval prolongation in critically ill patients: Prevalence, risk factors and associated medications

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