Validity of the Modified Charlson Comorbidity Index as Predictor of Short-term Outcome in Older Stroke Patients
| Autor: | Gian Paolo Ceda, Fabiola Giambanco, Licia Denti, Andrea Artoni, Umberto Scoditti, Monica Casella |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Context (language use) Severity of Illness Index Brain Ischemia Risk Factors Modified Rankin Scale Neoplasms Internal medicine medicine Humans Stroke Aged Retrospective Studies Aged 80 and over business.industry Rehabilitation Hazard ratio Odds ratio Middle Aged Prognosis medicine.disease Comorbidity Confidence interval Diabetes Mellitus Type 2 Cardiovascular Diseases Cohort Physical therapy Dementia Female Surgery Neurology (clinical) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Stroke and Cerebrovascular Diseases. 24:330-336 |
| ISSN: | 1052-3057 |
| DOI: | 10.1016/j.jstrokecerebrovasdis.2014.08.034 |
| Popis: | The modified Charlson Comorbidity Index (MCCI) has been proposed as a tool for adjusting the outcomes of stroke for comorbidity, but its validity in such a context has been evaluated in only a few studies and needs to be further explored, especially in elderly patients. We aimed to retrospectively assess the validity of the MCCI as a predictor of the short-term outcomes in a cohort of 297 patients with first-ever ischemic stroke, older than 60 years, and managed according to a clinical pathway. The poor outcome (PO) at 1 month, defined as a modified Rankin Scale score of 3-6, was the primary end point. Furthermore, a new comorbidity index has been developed, specific to our cohort, according to the same statistical approach used for the original CCI. The MCCI showed a positive association with PO (odds ratio [OR] 1.62; 95% confidence interval [CI] .98-2.68) and mortality (hazard ratio [HR] 1.85; 95% CI .94-3.61), not statistically significant and totally dependent on its association with the severity of neurologic impairment at onset. The new comorbidity index showed, as expected, a significant association with the PO and mortality with higher point estimates of OR (2.74; 95% CI 1.64-4.59) and HR (2.73; 95% CI 1.51-4.94), but this association was also dependent on stroke severity and premorbid disability. Our results do not support the validity of the MCCI as a predictor of the short-term outcomes in elderly stroke patients nor could we develop a more valid index from the available data. This suggests the need for development of disease- and age-specific indexes, possibly according to a prospective design. In any case, initial stroke severity, a strong predictor of outcome, is associated with the degree of comorbidity. |
| Databáze: | OpenAIRE |
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