Charlson comorbidity index (CCI) [Neurosurgery Wiki]

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====== Charlson comorbidity index (CCI) ======

http://touchcalc.com/calculators/cci_js

https://www.mdcalc.com/charlson-comorbidity-index-cci
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The [[purpose]] of the study was to assess whether the Charlson Comorbidity [[Index]] (CCI) was associated with in-hospital [[death]] and short-term functional outcome in [[elderly]] patients (age ≥ 70) with [[intracerebral hemorrhage]] (ICH).

This was a retrospective cohort of aged ICH patients (≥70 years old) admitted within 24 hours of [[ICH]] onset. The CCI was derived using [[hospital discharge]] ICD-9 CM codes and patient history obtained from standardized [[case report]] forms. [[Multivariable]] [[logistic regression]] was used to determine the independent effect of the CCI score on clinical outcomes.

In this [[cohort]] of 248 aged ICH patients, comorbid conditions were common, with CCI scores ranging from 2 to 12. Logistic regression showed that the CCI score was independently predictive of 1-month functional outcome (OR = 1.642, P < 0.001) and in-hospital death (OR = 1.480, P = 0.003). Neither ICH volume nor the presence of IVH was an independent predictive factor for the 1-month functional outcome or in-[[Hospital mortality]] (P < 0.05).

Comorbid medical conditions as assessed by the CCI independently influence short-term outcomes in aged ICH patients. The characteristics of the hematoma itself, such as [[intracerebral hemorrhage volume]] and the presence of [[IVH]], seem to have a reduced effect on it
((Zhang T, Chen R, Wen D, Wang X, Ma L. The prognostic value of the Charlson comorbidity index in aged patients with intracerebral hemorrhage. BMC Neurol. 2022 Nov 28;22(1):443. doi: 10.1186/s12883-022-02980-z. PMID: 36443745.)).

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[[Complication]]s in [[spine trauma]] patients with [[Ankylosing spinal disorder]]s may be driven by [[comorbidity]] burden rather than operative or injury-related factors. The [[Charlson Comorbidity Index]] (CCI) may be a valuable tool for the evaluation of this unique population
((Lakomkin N, Mikula AL, Pinter ZW, Wellings E, Alvi MA, Scheitler KM, Pennington Z, Lee NJ, Freedman BA, Sebastian AS, Fogelson JL, Bydon M, Clarke MJ, Elder BD. [[Perioperative]] [[risk stratification]] of spine trauma patients with ankylosing spinal disorders: a comparison of 3 quantitative indices. J Neurosurg Spine. 2022 May 27:1-7. doi: 10.3171/2022.4.SPINE211449. Epub ahead of print. PMID: 35623371.))
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[[Charlson Comorbidity Index]] (CCI) provides a simple way of predicting recurrence in patients with [[chronic subdural hematoma]] and should be incorporated into decision-making processes, when counseling patients
((Martinez-Perez R, Tsimpas A, Rayo N, Cepeda S, Lagares A. Role of the patient 
comorbidity in the recurrence of chronic subdural hematomas. Neurosurg Rev. 2020 
Mar 7. doi: 10.1007/s10143-020-01274-7. [Epub ahead of print] PubMed PMID:
32146611.
)).
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Data show that elderly with a good performance status and few co-morbidity may be treated as younger patients; moreover, age confirms a negative impact on survival while (CCI) ≤ 2 did not correlate with overall survival (OS)
((Balducci M, Fiorentino A, De Bonis P, Chiesa S, Manfrida S, D'Agostino GR,
Mantini G, Frascino V, Mattiucci GC, De Bari B, Mangiola A, Miccichè F,
Gambacorta MA, Colicchio G, Morganti AG, Anile C, Valentini V. Impact of age and 
co-morbidities in patients with newly diagnosed glioblastoma: a pooled data
analysis of three prospective mono-institutional phase II studies. Med Oncol.
2012 Dec;29(5):3478-83. doi: 10.1007/s12032-012-0263-3. Epub 2012 Jun 7. PubMed
PMID: 22674154.)).


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Charlson comorbidity index (CCI), functional status computed by the [[Karnofsky performance scale]] (KPS)), tumor characteristics (size, location, isocitrate dehydrogenase mutation, and O-6-methylguanine-DNA methyltransferase promoter methylation status), and treatment parameters (volumetrically quantified extent of resection and adjuvant therapy), evidence that aside established prognostic parameters (age and KPS) for [[glioblastoma]] patient outcome, the CCI additionally significantly impacts outcome and may be employed for preoperative patient stratification
((Ening G, Osterheld F, Capper D, Schmieder K, Brenke C. Charlson comorbidity
index: an additional prognostic parameter for preoperative glioblastoma patient
stratification. J Cancer Res Clin Oncol. 2015 Jan 11. [Epub ahead of print]
PubMed PMID: 25577223.)).

Maximal resection and radiochemotherapy treatment completion are associated with longer OS, and age alone should not preclude elderly patients from receiving surgery and adjuvant treatment. However, only a few patients were able to finish the proposed treatments. Poor performance and high comorbidity index status might compromise the benefit of treatment aggressiveness and must be considered in therapeutic decision
((Pereira AF, Carvalho BF, Vaz RM, Linhares PJ. Glioblastoma in the elderly:
Therapeutic dilemmas. Surg Neurol Int. 2015 Nov 16;6(Suppl 23):S573-S582.
eCollection 2015. PubMed PMID: 26664927.
)).

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===== References =====