Yıl 2020, Cilt 6 , Sayı 1, Sayfalar 67 - 72 2020-01-04

The prognostic role of Charlson comorbidity index for critically ill elderly patients

Abdulkerim YILDIZ [1] , Ali YİĞT [2] , Ali Ramazan BENLİ [3]


Objectives: Comorbidities represent a risk factor for adverse events in several critical illnesses. The aim of this study was to identify the relationship between the Charlson Comorbidity Index (CCI) with mortality and length of stay (LOS) in critically ill elderly patients.

Methods: A retrospective analysis was made of patients admitted to our tertiary adult intensive care unit (ICU) between January 2015 and January 2016. The impact of comorbidity was evaluated with the CCI. Other required data were retrieved from the patients' follow-up records.

Results: The study included a total of 251 patients. The mean age was 78.79 ± 6.70 years. The total mortality rate was 41.0%. The most common cause for admission was sepsis and acute respiratory failure (18.3% vs 18.3%). The median APACHE II score was significantly higher in non-survivors than survivors (31.0 [13.0-47.0] vs 21.0 [9.0-40.0]; p < 0.01). The median CCI was 2.0 (0.0-7.0) for survivors and 3.0 (1.0-10.0) for non-survivors. The CCI of non-survivors was significantly higher than that of survivors (p = 0.005). Patients with CCI > 3 had higher mortality than those with CCI 3 (p < 0.05). The odds ratio of the APACHE II score for mortality was 1.214 (95% CI: 1.154-1.276), and for CCI it was 1.320 (95% CI: 1.088-1.602). There was a significant positive correlation between CCI and LOS (r=0.147; p = 0.020).

Conclusions: CCI is strongly associated with both mortality and LOS. It can be used as a prognostic marker for elderly patients in critical care. 

Charlson comorbidity index, older patients, critically ill, mortality
  • 1. Zimmerman JE, Alzola C, Von Rueden KT. The use of benchmarking to identify top performing critical care units: a preliminary assessment of their policies and practices. J Crit Care 2003;18:76-86.
  • 2. Orsini J, Butala A, Salomon S, Studer S, Gadhia S, Shamian B, et al. Prognostic factors associated with adverse outcome among critically ill elderly patients admitted to the intensive care unit. Geriatr Gerontol Int 2015;15:889-94.
  • 3. Talib S, Sharif F, Manzoor S, Yaqub S, Kashif W. Charlson comorbidity index for prediction of outcome of acute kidney injury in critically ill patients. Iran J Kidney Dis 2017;11:115-23.
  • 4. Burch JB, Augustine AD, Frieden LA, Hadley E, Howcroft TK, Johnson R, et al. Advances in geroscience: impact on healthspan and chronic disease. J Gerontol A Biol Sci Med Sci 2014;69 Suppl 1:S1-3.
  • 5. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373-83.
  • 6. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011;173:676-82.
  • 7. Núñez JE, Núñez E, Fácila L, Bertomeu V, Llàcer A, Bodí V, et al. [Prognostic value of Charlson comorbidity index at 30 days and 1 year after acu]te myocardial infarction]. Rev Esp Cardiol 2004;57:842-9. [Article in Spanish]
  • 8. Tripathy S, Mishra JC, Dash SC. Critically ill elderly patients in a developing world--mortality and functional outcome at 1 year: a prospective single-center study. J Crit Care 2014;29:474.e7-13.
  • 9. Pisani MA. Considerations in caring for the critically ill older patient. J Intens Care Med 2009;24:83-95.
  • 10. Falsetti L, Viticchi G, Tarquinio N, Silvestrini M, Capeci W, Catozzo V, et al. Charlson comorbidity index as a predictor of in-hospital death in acute ischemic stroke among very old patients: a single-cohort perspective study. Neurol Sci 2016;37:1443-8.
  • 11. Chelluri L, Pinsky MR, Donahoe MP, Grenvik A. Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 1993;269:3119-23.
  • 12. Zekry D, Loures Valle BH, Lardi C, Graf C, Michel JP, Gold G, et al. Geriatrics index of comorbidity was the most accurate predictor of death in geriatric hospital among six comorbidity scores. J Clin Epidemiol 2010;63:1036-44.
  • 13. Buntinx F, Niclaes L, Suetens C, Jans B, Mertens R, Van den Akker M. Evaluation of Charlson's comorbidity index in elderly living in nursing homes. J Clin Epidemiol 2002;55:1144-7.
  • 14. Quach S, Hennessy DA, Faris P, Fong A, Quan H, Doig C. A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients. BMC Health Serv Res 2009;9:129.
  • 15. Poses RM, McClish DK, Smith WR, Bekes C, Scott WE. Prediction of survival of critically ill patients by admission comorbidity. J Clin Epidemiol 1996;49:743-7.
Birincil Dil en
Konular Genel ve Dahili Tıp, Hematoloji
Bölüm Original Article
Yazarlar

Orcid: 0000-0002-9596-4042
Yazar: Abdulkerim YILDIZ (Sorumlu Yazar)
Kurum: Department of Hematology, University of Health Sciences, Dışkapı Yıldırım Beyazit, Training and Research Hospital, Ankara, Turkey
Ülke: Turkey


Orcid: 0000-0002-7828-9698
Yazar: Ali YİĞT
Kurum: Department of Internal Medicine, Karabük University, Karabuk Training and Research Hospital, Karabük, Turkey
Ülke: Turkey


Orcid: 0000-0003-0039-1497
Yazar: Ali Ramazan BENLİ
Kurum: Department of Family Medicine, Karabuk University School of Medicine, Karabük, Turkey
Ülke: Turkey


Tarihler

Yayımlanma Tarihi : 4 Ocak 2020

EndNote %0 The European Research Journal The prognostic role of Charlson comorbidity index for critically ill elderly patients %A Abdulkerim YILDIZ , Ali YİĞT , Ali Ramazan BENLİ %T The prognostic role of Charlson comorbidity index for critically ill elderly patients %D 2020 %J The European Research Journal %P -2149-3189 %V 6 %N 1 %R doi: 10.18621/eurj.451391 %U 10.18621/eurj.451391