Specific Comorbidity Index Research Articles

Pre-Transplant Comorbidity as An Outcome Predictor in Hematopoietic Cell Transplantation for Severe Aplastic Anemia

A new hematopoietic cell transplantation specific comorbidity index (HCT-CI), which was modeled to effectively capture comorbidity and predict post-transplant outcomes, has been evaluated in a cohort of patients with a variety of hematologic disorders. In this study, we applied the HCT-CI to 77 patients with severe aplastic anemia who underwent HCT at the Asan Medical Center, Seoul, Korea between February 1995 and September 2007. Pre-transplant HCT-CI score was calculated in each patient using the clinico-pathologic data, which were retrieved from Asan Medical Center Bone Marrow Transplantation Registry Database. HCT-CI score was 0 in 54 patients (70%), 1 in 16 (21%), 2 in four (5%), and 4 in one (1%). The most prevalent comorbidity captured by the HCT-CI was infection (n=11) followed by arrhythmia (n=6). During a median follow-up period of 54.4 months (range, 4.0 to 159.0 months), 19 patients died and 16 experienced primary or secondary graft failure. The 5-year probabilities of overall survival (OS) and event-free survival (EFS) were 73.4% and 63.3%, respectively. OS and EFS were significantly different according to HCT-CI score; OS 86.6% and EFS 74.3% in patients with score 0 versus 43.5% and 38.5% in those with score 1 or more (P<0.001 for OS and P=0.001 for EFS). Other significant prognostic factors for OS were age (<30 years vs. ≥30, 90.8% vs. 58.3%, P=.002), pre-transplant transfusion amount (<50 units vs. ≥50, 93.0% vs. 61.0%; P=.005) and time from diagnosis to HCT (<120 days vs. ≥120, 85.2% vs. 61.4%; P=.013), and prognostic factors for EFS were age (<30 years vs. ≥30, 81.0% vs. 48.4%, P=.003) and time from diagnosis to HCT (<120 days vs. ≥120, 77.4% vs. 48.3%; P=.007). Multivariate analysis after adjustment for other variables demonstrated that HCT-CI score (HR 10.022, P<.001 for OS; HR 4.644, P<.001 for EFS), age (HR 8.447, P=.002 for OS; HR 4.060, P=.003 for EFS), time from diagnosis to HCT (HR 5.783, P=.002 for OS; HR 3.956, P=.002 for EFS) were independently significant prognostic factors for both OS and EFS. In conclusion, our data indicate that the presence of pre-transplant comorbidity assessed by HCT-CI may predict worse outcomes after HCT in severe aplastic anemia.

Myelodysplastic Syndrome (MDS)-Specific Comorbidity Index for Predicting the Impact of Extra-Hematological Comorbidities on Survival of Patients with MDS

Myelodysplastic syndromes (MDS) occur mainly in older persons, who are likely to be affected with extra-hematological comorbidities. Recent findings suggest that proper assessment of comorbidities is useful to predict the outcome of MDS patients receiving allogeneic transplantation. However, the results obtained in this highly selected subset of patients cannot be applied to the whole MDS population. In this study, we evaluated the impact of extra-hematological comorbidities on the natural history of MDS with the aim of developing a specific prognostic index. The patients comprised a “learning cohort”, in which we defined the set of variables to be included in the prognostic model and their weighted scores, and a “validation cohort”, in which we confirmed the prognostic value of the scoring system. The learning cohort included 840 MDS patients diagnosed at the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, between 1992 and 2006, while the validation cohort consisted of 504 patients seen at the Heinrich-Heine-University Hospital, Duesseldorf, Germany, between 1982 and 2006. All cases were classified according to the WHO criteria. Patients who underwent allogeneic transplantation or intensive chemotherapy were censored at the time of the procedure. One or more comorbidities were present in 455 (54%) patients in the learning cohort at the time of diagnosis: the older the age, the higher the prevalence. Cardiac disease was the most frequent extra-hematological morbidity (25% of patients) and the main cause (63%) of non-leukemic death (NLD). In a Cox multivariable analysis with time-dependent covariates, the onset of a comorbidity significantly affected the risk of NLD (HR=2.29, P<.001) and worsened overall survival (OS, HR=1.51, P=.01). Patients who developed RBC transfusion-dependency had a significantly higher risk of NLD (HR=4.31 P=<.001), cardiac disease and death (HR 4.16 and HR 4.88, respectively; P=<.001). In this group, serum ferritin levels were significantly associated with the risk of cardiac disease and death (P=.001). The onset of cardiac, liver, renal, pulmonary disease and solid tumor were found to independently affect the risk of NLD in a multivariable Cox regression (HR from 3.57 to 1.97; P values from <0.001 to 0.04). Based on these results, we developed a dynamic prognostic model (MDS-specific comorbidity index, MDS-CI) for predicting the effect on NLD and OS of comorbidities either present at the time of diagnosis or occurring during the follow-up. Risk scores for each comorbidity were estimated from the regression coefficients (Table 1).Table 1. MDS-specific comorbidity index (MDS-CI)ComorbidityScoreCardiac disease2Moderate-to-severe hepatic disease1Severe pulmonary disease1Renal disease1Solid tumor1Risk groups: Low (score 0), Intermediate (score 1–2), High (score >2).MDS-CI allowed us to identify 3 groups of patients with different probability of NLD and OS (P<.001). The prognostic value of the MDS-CI was then evaluated in the validation cohort of patients, where the 3 MDS-CI risk groups showed significantly different probabilities of NLD (P<.001) and OS (P=.005), with a 2-year risk of NLD since diagnosis of 24%, 42% and 61% in the low, intermediate and high risk group, respectively. In summary, extra-hematological comorbidities significantly worsen the natural history of MDS patients, specifically increasing the risk of NLD. In particular, transfusion-dependency and secondary iron overload are associated with a higher risk of cardiac complications. The MDS-CI improves our ability to stratify the outcome of MDS patients and may be a useful tool for clinical decision-making. An accurate evaluation of extra-hematological comorbidity should be part of the prognostic assessment of patients with MDS.

Busulfan and Fludarabine Conditioning Regimen Negates the Impact of Comorbidity Score on Nonrelapse Mortality in Patients with AML/MDS

BACKGROUND: Comorbidities as measured by newly developed Hematopoietic cell transplantation specific comorbidity index (HCT-CI) increases non relapse mortality in patients with hematological malignancies undergoing allogeneic transplantation. Whether this applies to recently treated patients with newer reduced toxicity regimens is not known. To evaluate this, we studied the factors influencing non relapse mortality in patients with AML/MDS.METHODS: 840 consecutive patients with AML/MDS undergoing allogeneic transplantation between January 1996 and April 2008 from a matched related or unrelated donor at our institution were studied. Information about disease characteristics, treatment, and outcomes was prospectively recorded in the departmental database. Comorbidities were retrospectively scored as previously described (Sorror et al Blood 106: 2912–2919, 2005). Predictors of non-relapse mortality(NRM) at 2 years post SCT were evaluated on univariate analysis using Cox's proportional hazards model and included age, sex, disease status at transplant, donor type, graft type, conditioning regimen (reduced intensity, ablative IV Busulfan(Bu) and Fludarabine(Flu), all other ablative regimens), and HCT-CI comorbidity score. Factors significant at the 0.1 level on univariate analysis were considered for classification and regression tree analysis (CART) to adjust for confounding and interaction effects. Statistical significance was defined at the 0.05 level, and cells including less than 10 patients were considered terminal in the CART analysis.RESULTS: There were 470(56%) males and 370(44%) females with a median age of 50 (range 18–77) years. 21% of patients were older than 60 years. HCT-CI comorbidity scores were as follows: 0 in 16% of patients, 1 in 13%, 2 in 13%, 3 or more in 58%. Donors were matched related for 58% of patients and unrelated for 42%. At the time of transplant, 22% of patients were in first complete remission (CR), 15% in second or third CR, and 63% had active disease. 36% of patients had reduced intensity conditioning regimen; 39% had myeloablative regimen consisting of Flu and Bu, and the remaining 25% had other myeloablative regimens. Cumulative incidence of NRM at 2 years was 26% (23–30). Univariate analysis showed that age > 60 (HR 1.6; p 0.002), disease status beyond first complete remission (HR 2.7; p <0.001), matched unrelated donor (HR 1.6; p 0.001), regimen other than Flu/Bu (HR 2.6; p<0.001), and a comorbidity score greater than 2 (HR 1.4; p 0.03) were associated with higher NRM. CART analysis (fig) showed that the use of Flu/Bu conditioning was the primary predictor of lower NRM. Age older than 60 years was the only additional significant predictor of NRM in patients who received Flu/Bu (HR 3.1; p 0.01). In patients who did not receive Flu/Bu, disease status at transplantation was the primary predictor of NRM with CR1 patients having a significantly lower incidence of NRM (CI =16%). The impact of donor type was only significant in patients who were not in CR1 with recipients of a matched related graft having a significantly lower NRM (CI=29%) than recipients of a matched unrelated graft (CI=46%). Comorbidity score did not significantly predict outcome in this analysis.CONCLUSION: Flu/Bu, a fully ablative reduced toxicity conditioning regimen, results in very low NRM, nullifying the impact of comorbidities. [Display omitted]

Red Blood Cell Transfusion Dependence and Outcome after Allogeneic Peripheral Blood Stem Cell Transplantation in Patients with de Novo Myelodysplastic Syndrome (MDS)

The prognosis of patients with de novo myelodysplastic syndrome (MDS) who are red blood cell transfusion-dependent (TD) and receive supportive care is inferior to that of patients who do not require transfusions. Whether TD also affects outcome after allogeneic transplantation is unknown. Consequently, in 172 de novo MDS patients (median age, 51 years), we analyzed the impact of TD on outcome after high-dose conditioning and allogeneic peripheral blood stem cell transplantation (PBSCT). With a median follow-up of 37 months, the probability of 3-year overall survival (OS) did not differ significantly between patients who were TD and those who were not TD before PBSCT (P=.1); however, transfusion burden, as reflected by ferritin levels, was correlated with a greater probability of severe acute graft-versus-host disease (aGVHD; P=.03) and a higher comorbidity index (P=.01), and OS was inferior in those patients with a ferritin level>1000 microg/L before PBSCT (P=.03). In multivariate analysis, only marrow myeloblast count (P=.01) and comorbidity index (P=.001) had a significant impact on OS. Our data do not identify TD as an independent negative prognostic factor for outcome after allogeneic PBSCT' however, iron overload (presumably transfusion-related) may contribute to poor transplantation success by adding to the overall comorbidities. Whether clinical intervention in the form of iron chelation can improve the outcome of allogeneic PBSCT in TD patients with MDS remains to be determined.

Comparison of Outcomes of HLA-Matched Related, Unrelated, or HLA-Haploidentical Related Hematopoietic Cell Transplantation following Nonmyeloablative Conditioning for Relapsed or Refractory Hodgkin Lymphoma

We compared the outcome of nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) for patients with relapsed or refractory Hodgkin lymphoma (HL) based on donor cell source. Ninety patients with HL were treated with nonmyeloablative conditioning followed by HCT from HLA-matched related, n=38, unrelated, n=24, or HLA-haploidentical related, n=28 donors. Patients were heavily pretreated with a median of 5 regimens and most patients had failed autologous HCT (92%) and local radiation therapy (83%). With a median follow-up of 25 months, 2-year overall survivals, progression-free survivals (OS)/(PFS), and incidences of relapsed/progressive disease were 53%, 23%, and 56% (HLA-matched related), 58%, 29%, and 63% (unrelated), and 58%, 51%, and 40% (HLA-haploidentical related), respectively. Nonrelapse mortality (NRM) was significantly lower for HLA-haploidentical related (P=.02) recipients compared to HLA-matched related recipients. There were also significantly decreased risks of relapse for HLA-haploidentical related recipients compared to HLA-matched related (P=.01) and unrelated (P=.03) recipients. The incidences of acute grades III-IV and extensive chronic graft-versus-host disease (aGVHD, cGVHD) were 16%/50% (HLA-matched related), 8%/63% (unrelated), and 11%/35% (HLA-haploidentical related). These data suggested that salvage allogeneic HCT using nonmyeloablative conditioning provided antitumor activity in patients with advanced HL; however, disease relapse/progression continued to be major problems. Importantly, alternative donor stem cell sources are a viable option.

Does the Hematopoietic Cell Transplantation Specific Comorbidity Index Predict Transplant Outcomes? A Validation Study in a Large Cohort of Umbilical Cord Blood and Matched Related Donor Transplants

The hematopoietic cell transplantation specific comorbidity index (HCT-CI) has been recently proposed to predict the probability of nonrelapse mortality (NRM) and overall survival (OS) in allogeneic HCT recipients while taking into account any pretransplant comorbidity. We tested the validity of the HCT-CI in a cohort of 373 adult HCT recipients (184 matched-related donor and 189 unrelated umbilical cord blood) who received a myeloablative (N = 150) or nonmyeloablative (N = 223) conditioning regimen. HCT-CI scores of 0, 1, 2, and ≥3 were present in 58 (16%), 56 (15%), 64 (17%), and 195 (52%) patients, respectively. Pulmonary conditions were the most common comorbidity. Cumulative incidence of NRM at 2 years was 10%, 20%, 24%, and 28% for HCT-CI scores of 0, 1, 2, and ≥3, respectively (P = .01). The corresponding probability of OS at 2 years was 72%, 67%, 51%, and 48%, respectively (P < .01). On multivariate analyses adjusted for recipient age, disease risk, donor source, and conditioning regimen intensity, the relative risks for NRM for HCT-CI scores of 1, 2, and ≥3 (compared to a score of 0) were 2.0 (95% confidence intervals, 0.8–5.3), 2.6 (1.0–6.7), and 3.2 (1.4-7.4), respectively. The risks for overall mortality were 1.2 (0.6-2.1), 2.0 (1.1-3.4), and 2.1 (1.3-3.3), respectively. In subgroup analyses, the HCT-CI score did not consistently predict NRM and OS among different donor sources and conditioning regimens. The HCT-CI, although a useful tool for capturing pretransplant comorbidity and risk-assessment, needs to be further validated prior to adopting it for routine clinical use.

Hematopoietic cell transplantation–specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences

A new hematopoietic cell transplantation-specific comorbidity index (HCT-CI) was effective in predicting outcomes among patients with hematologic malignancies who underwent HCT at Fred Hutchinson Cancer Research Center (FHCRC). Here, we compared the performance of the HCT-CI to 2 other indices and then tested its capacity to predict outcomes among 2 cohorts of patients diagnosed with a single disease entity, acute myeloid leukemia in first complete remission, who underwent transplantation at either FHCRC or M. D. Anderson Cancer Center (MDACC). FHCRC patients less frequently had unfavorable cytogenetics (15% versus 36%) and HCT-CI scores of 3 or more (21% versus 58%) compared with MDACC patients. We found that the HCT-CI had higher sensitivity and outcome predictability compared with the other indices among both cohorts. HCT-CI scores of 0, 1 to 2, and 3 or more predicted comparable nonrelapse mortality (NRM) among FHCRC and MDACC patients. In multivariate models, HCT-CI scores were associated with the highest hazard ratios (HRS) for NRM and survival among each cohort. The 2-year survival rates among FHCRC and MDACC patients were 71% versus 56%, respectively. After adjustment for risk factors, including HCT-CI scores, no difference in survival was detected (HR: 0.98, P = .94). The HCT-CI is a sensitive and informative tool for comparing trial results at different institutions. Inclusion of comorbidity data in HCT trials provides valuable, independent information.

The Predictive Value of the Hematopoietic Cell Transplantation (HCT)-Specific Comorbidity Index (CI) in Recipients of Umbilical Cord Blood (UCB) Transplantation.

The hematopoietic cell transplantation (HCT)-specific comorbidity index (CI) has been shown to predict nonrelapse mortality (NRM) and overall survival (OS) after sibling and unrelated adult volunteer donor transplantation (Sorror Blood 2005, 106:2912). We retrospectively studied the predictive value of the HCT-CI in a cohort of 182 patients who underwent an umbilical cord blood (UCB) transplant for advanced or high risk malignancy at the University of Minnesota, between August 2001 and May 2006. Patients receive either a myeloablative (MA, n=54) or nonmyeloablative (NST, n=128) conditioning regimens followed by cyclosporine and mycophenolate mofetil in both groups. Patients received single (n=27) or double (n=155) UCB grafts that were HLA-matched 4–6/6 matched to the recipient, and for double UCB grafts 4–6/6 matched each other as well. All received G-CSF from day 0 to ANC > 2500 for three days. Antibiotic prophylaxis, blood products, and growth factor administration followed the same institutional guidelines. Patients' median age was 47 (range: 18–69), median weight 78 kg (r: 45–149), and 51% were CMV seropositive. Thirty patients, all in the NST group, had prior autologous transplant. HCT-CI scores were assigned retrospectively; scores were zero (n=18%), 1–2 (n=33%), or >2 (n=49%) and were comparable between the MA and NST groups. The median nucleated cell dose (NCD) was 3.5 X 107/kg (range: 1.1–6.8) and CD34+ cell dose was 4.7 X 105/kg (range: 0.7–18.8) with no difference in recipients of singles and double UCB grafts or MA and NST conditioning regimens. The NRM at 1-year was 13% (95%CI, 2–24) for patients with HCT-CI score of zero, 20% (95%CI, 10–30) for scores 1–2, and 22% (95%CI, 14–30) for score > 2 (p=.46). In multivariate regression model, HCT-CI score was not an independent predictor of NRM [HCT-CI score Zero RR 1(ref), 1–2 RR 1.5 (95%CI, 0.5–4.5, p=.5; >2 RR 1.8 (95%CI, 0.6–5.3), p=.27], whereas patients who received a NST conditioning had significantly lower relative risk (RR) of NRM (RR 0.5, 95%CI, 0.2–1.0, p=.05). The 1-yr OS was 72% (95%CI, 53–84) for patients with score zero, 65% (95%CI, 52–76) for scores 1–2, and 56% (95%CI, 29–65) for scores >2. In Cox regression analysis the HCT-CI was not associated with the risk of death, in contrast to disease risk group, development of grades II–IV acute GVHD, and interval between diagnosis and transplantation (Table). While the HCT-CI was not predictive of either NRM nor OS in recipients of UCBT, high OS for the group as whole, patient numbers and selection procedures may explain, at least in part, these results. However, it is also possible that the HCT-CI scoring system may not yet be optimized and some medical conditions may have greater impact on HSC transplantation outcome as compared to others.FactorsRR of Death (95% C.I.)P-valueHCT-Co-Morbidity Score0*1.01–21.4 (0.6–3.1).40>21.9 (0.9–3.9).09ConditioningMyeloablative*1.0Nonmyeloablative0.9 (0.6–1.6).83Disease RiskStandard*1.0High3.1 (1.5–6.5)<.01Acute GVHDGrades 0–I1.0Grades II–IV0.5 (0.3–0.9)<.01Years from Dx to TX< 1*1.01–20.8 (0.4–1.5).50>20.5 (0.3–0.9).02* reference group

Cloretazine (VNP40101M), a Novel Sulfonylhydrazine Alkylating Agent, in Patients Age 60 Years or Older With Previously Untreated Acute Myeloid Leukemia

Cloretazine (VNP40101M) is a sulfonylhydrazine alkylating agent with significant antileukemia activity. A multicenter phase II study of cloretazine was conducted in patients 60 years of age or older with previously untreated acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS). Cloretazine 600 mg/m2 was administered as a single intravenous infusion. Patients were stratified by age, performance score, cytogenetic risk category, type of AML, and comorbidity. One hundred four patients, median age 72 years (range, 60 to 84 years), were treated on study. Performance status was 2 in 31 patients (30%) and no patient had a favorable karyotype. Forty-seven patients (45%) had cardiac disease, 25 patients (24%) had hepatic disease, and 19 patients (18%) had pulmonary disease, defined as per the Hematopoietic Cell Transplantation-Specific Comorbidity Index, at study entry. The overall response rate was 32%, with 29 patients (28%) achieving complete response (CR) and four patients (4%) achieving CR with incomplete platelet recovery. Response rates in 44 de novo AML patients, 45 secondary AML patients, and 15 high-risk MDS patients were 50%, 11%, and 40%, respectively. Response by cytogenetic risk category was 39% in 56 patients with intermediate cytogenetic risk and 24% in 46 patients with unfavorable cytogenetic risk. Nineteen (18%) patients died within 30 days of receiving cloretazine therapy. Median overall survival was 94 days, with a 1-year survival of 14%; the median duration of survival was 147 days, with a 1-year survival of 28% for those who achieved CR. Cloretazine has significant activity and modest extramedullary toxicity in elderly patients with AML or high-risk MDS. Response rates remain consistent despite increasing age and comorbidity.

Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT

AbstractWe previously reported that the Charlson Comorbidity Index (CCI) was useful for predicting outcomes in patients undergoing allogeneic hematopoietic cell transplantation (HCT). However, the sample size of patients with scores of 1 or more, captured by the CCI, did not exceed 35%. Further, some comorbidities were rarely found among patients who underwent HCT. Therefore, the current study was designed to (1) better define previously identified comorbidities using pretransplant laboratory data, (2) investigate additional HCT-related comorbidities, and (3) establish comorbidity scores that were suited for HCT. Data were collected from 1055 patients, and then randomly divided into training and validation sets. Weights were assigned to individual comorbidities according to their prognostic significance in Cox proportional hazard models. The new index was then validated. The new index proved to be more sensitive than the CCI since it captured 62% of patients with scores more than 0 compared with 12%, respectively. Further, the new index showed better survival prediction than the CCI (likelihood ratio of 23.7 versus 7.1 and c statistics of 0.661 versus 0.561, respectively, P < .001). In conclusion, the new simple index provided valid and reliable scoring of pretransplant comorbidities that predicted nonrelapse mortality and survival. This index will be useful for clinical trials and patient counseling before HCT. (Blood. 2005;106: 2912-2919)

Allogeneic Stem Cell Transplantation to cure Acute Myeloid Leukemia in elderly patients

Outcomes for elderly patients with acute myeloid leukemia (AML) remain poor with standard therapies. Historically this age group has been excluded from treatment with allogeneic stem cell transplantation (allo-SCT) due to worries of excessive treatment related morbidity and mortality. However, transplantation outcomes have dramatically improved in the last decade due to the widespread use of less ablative conditioning regimens, improved supportive care, and improved patient selection based on prognostic tools such as the hematopoietic cell transplant specific comorbidity index. These have all led to an increasing acceptance of allo-SCT as a potential treatment modality in elderly patients with AML. This review addresses current strategies for patient selection and efficacy data for allo-SCT in elderly patients with AML. DOI: http://dx.doi.org/10.3126/jaim.v1i1.5840 Journal of Advances in Internal Medicine. 2012; 1(1): 43-49

Points from Letters: Alcohol and Road Accidents

<h3>Background</h3> Specific comorbidity index can guide the management of psoriatic arthritis (PsA) patients and optimize their outcomes. So far, no disease-specific models are currently available for this purpose. <h3>Objectives</h3> 1. identify comorbidities with greatest impact on PsA patients9 health status. 2. develop and validate a prospectively applicable comorbidity index for classifying PsA patients according to their comorbid conditions which might alter their risk of hospitalization and mortality. <h3>Methods</h3> This was a retrospective multicenter cohort analysis of PsA patients in a rheumatology clinical registry, assessing the effect of different comorbidities measured at patients9 visits over 10-years period, on predicting future death and hospitalization. A weighted index that takes into account the number and seriousness of comorbid disease was developed in a cohort of 1707 PsA patients monitored over 10-years. Logistic and Cox Regression analyses were implemented to estimate the risk of mortality. Regression coefficients were used to develop the morbidity index score. ROC curve for the invented index was used to evaluate the discriminating ability of the index and identify different cutoff values that can delineate patients at different stages for risk of death. Disease activity parameters were considered. <h3>Results</h3> PsA patients who had higher incidence of comorbid condition and were at high risk of hospitalization were men, with older age at disease onset, high BMI at baseline (p&lt;0.05). The most prevalent comorbidities strongly associated with the 10-year death risk or hospitalization in PsA patients were: Cardiovascular (7 comorbidities), osteoporosis, falls, depression/ anxiety, diabetes mellitus, renal and liver diseases, lung and GIT affection, as well as infection (p&lt;0.001). Multivariate regression analysis identified Multidimensional Disease Relapse score (including 5 parameters: DAPSA, PASI, Functional disability score, ESR and CRP) as independent predictor for disease status associated with the 10-year death risk or hospitalization (Wald χ²=9.2, p=0.002, OR=24.6). Binary regression analysis revealed that: male gender, cardiovascular diseases, evident fall risk, diabetes, infection, anxiety, and the multidimensional relapse score were significant independent factors affecting the 10-years outcome of the disease. A comorbidity index weighted according to the regression coefficient of the variables extracted through the logistic regression analysis was developed. The score ranges from 0 to 38. A cut off point of 14.5 was associated with a sensitivity of 97.5% and a specificity of 87%. Validation using ROC curve revealed AUC of 98.5%. <h3>Conclusions</h3> The PsA-comorbidity index is a valid method for estimating risk of death in PsA patients. It enables the clinicians to include comorbidities assessment and management in their standard practice. It can be used to predict resource utilization, identify targets for reducing high costs, by prospectively identifying PsA patients at high risk. Rigorous application of systematic evaluation of comorbidities may permit earlier detection, which may ultimately result in an improved outcome of patients with PsA. <h3>Disclosure of Interest</h3> None declared