Weighted Comorbidity Index Research Articles

A comparative analysis of Charlson's weighted index of comorbidity and perforated peptic ulcer scores in predicting postoperative mortality and high comprehensive complication index.

Limited data exists on Charlson's weighted index of comorbidity (WIC) predictability for postoperative outcomes following perforated peptic ulcer (PPU) surgery. This study assesses the utility of WIC and other predictive scores in forecasting both postoperative mortality and morbidity in PPU. Patients with PPUs operated between 2018 and 2021 in a Malaysian tertiary referral center were included. Clinical data were retrospectively analyzed for association with mortality and morbidity measured with the Comprehensive Complication Index (CCI). Predictability of WIC and other predictors were examined using area under receiver-operator characteristic (ROC) curve (AUC). Among 110 patients included, 18 died (16.4%) and 36 (32.7%) had significant morbidity postoperatively (High CCI, ≥26.2). Both mortality and high CCI were associated with age >65years, female sex, comorbidities (diabetes mellitus, hypertension, and renal disease), and American Society of Anesthesiologist score >2. Most patients who died had renal dysfunction, metabolic acidosis, lactate >2mmol/L upon presentation preoperatively. While surgery >24h after presentation correlated with mortality and high CCI, the benefit of earlier surgery <6h or <12h was not demonstrated. WIC (AUC, 0.89; 95% CI, 0.81-0.99) showed similar predictability to Peptic Ulcer Perforation (PULP) (AUC, 0.97; 95% CI, 0.93-1.00) for mortality. PULP effectively predicted high CCI (AUC, 0.83; 95% CI, 0.73-0.93; p<0.001). WIC is valuable in predicting mortality, highlighting the importance of comorbidity in risk assessment. PULP score was effective in predicting both mortality and high CCI. Early identification of patients with high perioperative risk will facilitate patients' triage for escalated care, leading to a better outcome.

A retrospective study of Aeromonas hydrophila infections at a university tertiary hospital in Saudi Arabia

BackgroundAeromonas hydrophila can cause a wide range of diseases and is mainly found in patients with underlying diseases. Globally the data on Aeromonas infections is limited, and no studies have been published about the situation in Saudi Arabia. The aim of this study was to investigate the risk factors, clinical presentation, treatment, and outcomes of Aeromonas infections in Saudi Arabia.MethodsA retrospective study was performed at a tertiary university hospital with 1000 beds in Jeddah, Saudi Arabia. All patients 14 years and older with Aeromonas-positive cultures between January 1, 2015, and December 31, 2022 were included. Patient information was extracted from the electronic health records, including patient demographics, comorbidities, presenting symptoms, source of infection, human immunodeficiency virus status, culture results and antimicrobial susceptibility, use of immunosuppressive medication, and 30-day mortality.ResultsIn total 24 patients were identified with Aeromonas hydrophila-positive cultures, 22 of which were males (91.7%), and most (75%) had hospital-acquired infections. The 30-day mortality was 20.8%. All Aeromonas cultures were susceptible to gentamicin, cefepime, and ciprofloxacin, while the majority were resistant to ceftazidime (83.3%) and meropenem (62.5%). The most common disease presentation was skin and soft tissue infection (33.3%), the most common clinical sign was fever (58.3%), and the most common symptom was abdominal pain (37.5%). Comorbidities were very common (median 3, range 1–7). Pitt bacteremia score (p < 0.001), Charlson weighted comorbidity index (p < 0.02), international normalized ratio (p < 0.005), and the number of comorbidity factors (p < 0.05) were all associated with 30-day mortality due to Aeromonas infection. The number of comorbidities had the best predictive value (83.3%) of 30-day mortality (p < 0.05, Odds ratio 3.253, 95% confidence interval: 1.088–9.729).ConclusionsAeromonas hydrophila is an important pathogen to consider in nosocomial infections. The number of comorbidities had the best predictive value of 30-day mortality. The susceptibility pattern of this organism indicates that, in Saudi Arabia, when an Aeromonas infection is suspected, treatment with quinolone along with other broad-spectrum antibiotics should be started until the culture and susceptibility results are known.

The risk of clinical complications and death among pregnant women with COVID-19 in the Cerner COVID-19 cohort: a retrospective analysis

BackgroundPregnant women are potentially a high-risk population during infectious disease outbreaks such as COVID-19, because of physiologic immune suppression in pregnancy. However, data on the morbidity and mortality of COVID-19 among pregnant women, compared to nonpregnant women, are sparse and inconclusive. We sought to assess the impact of pregnancy on COVID-19 associated morbidity and mortality, with particular attention to the impact of pre-existing comorbidity.MethodsWe used retrospective data from January through June 2020 on female patients aged 18–44 years old utilizing the Cerner COVID-19 de-identified cohort. We used mixed-effects logistic and exponential regression models to evaluate the risk of hospitalization, maximum hospital length of stay (LOS), moderate ventilation, invasive ventilation, and death for pregnant women while adjusting for age, race/ethnicity, insurance, Elixhauser AHRQ weighted Comorbidity Index, diabetes history, medication, and accounting for clustering of results in similar zip-code regions.ResultsOut of 22,493 female patients with associated COVID-19, 7.2% (n = 1609) were pregnant. Crude results indicate that pregnant women, compared to non-pregnant women, had higher rates of hospitalization (60.5% vs. 17.0%, P < 0.001), higher mean maximum LOS (0.15 day vs. 0.08 day, P < 0.001) among those who stayed < 1 day, lower mean maximum LOS (2.55 days vs. 3.32 days, P < 0.001) among those who stayed ≥1 day, and higher moderate ventilation use (1.7% vs. 0.7%, P < 0.001) but showed no significant differences in rates of invasive ventilation or death. After adjusting for potentially confounding variables, pregnant women, compared to non-pregnant women, saw higher odds in hospitalization (aOR: 12.26; 95% CI (10.69, 14.06)), moderate ventilation (aOR: 2.35; 95% CI (1.48, 3.74)), higher maximum LOS among those who stayed < 1 day, and lower maximum LOS among those who stayed ≥1 day. No significant associations were found with invasive ventilation or death. For moderate ventilation, differences were seen among age and race/ethnicity groups.ConclusionsAmong women with COVID-19 disease, pregnancy confers substantial additional risk of morbidity, but no difference in mortality. Knowing these variabilities in the risk is essential to inform decision-makers and guide clinical recommendations for the management of COVID-19 in pregnant women.

Combined associations of body mass index and adherence to a Mediterranean-like diet with all-cause and cardiovascular mortality: A cohort study.

It is unclear whether the effect on mortality of a higher body mass index (BMI) can be compensated for by adherence to a healthy diet and whether the effect on mortality by a low adherence to a healthy diet can be compensated for by a normal weight. We aimed to evaluate the associations of BMI combined with adherence to a Mediterranean-like diet on all-cause and cardiovascular disease (CVD) mortality. Our longitudinal cohort design included the Swedish Mammography Cohort (SMC) and the Cohort of Swedish Men (COSM) (1997-2017), with a total of 79,003 women (44%) and men (56%) and a mean baseline age of 61 years. BMI was categorized into normal weight (20-24.9 kg/m2), overweight (25-29.9 kg/m2), and obesity (30+ kg/m2). Adherence to a Mediterranean-like diet was assessed by means of the modified Mediterranean-like diet (mMED) score, ranging from 0 to 8; mMED was classified into 3 categories (0 to <4, 4 to <6, and 6-8 score points), forming a total of 9 BMI × mMED combinations. We identified mortality by use of national Swedish registers. Cox proportional hazard models with time-updated information on exposure and covariates were used to calculate the adjusted hazard ratios (HRs) of mortality with their 95% confidence intervals (CIs). Our HRs were adjusted for age, baseline educational level, marital status, leisure time physical exercise, walking/cycling, height, energy intake, smoking habits, baseline Charlson's weighted comorbidity index, and baseline diabetes mellitus. During up to 21 years of follow-up, 30,389 (38%) participants died, corresponding to 22 deaths per 1,000 person-years. We found the lowest HR of all-cause mortality among overweight individuals with high mMED (HR 0.94; 95% CI 0.90, 0.98) compared with those with normal weight and high mMED. Using the same reference, obese individuals with high mMED did not experience significantly higher all-cause mortality (HR 1.03; 95% CI 0.96-1.11). In contrast, compared with those with normal weight and high mMED, individuals with a low mMED had a high mortality despite a normal BMI (HR 1.60; 95% CI 1.48-1.74). We found similar estimates among women and men. For CVD mortality (12,064 deaths) the findings were broadly similar, though obese individuals with high mMED retained a modestly increased risk of CVD death (HR 1.29; 95% CI 1.16-1.44) compared with those with normal weight and high mMED. A main limitation of the present study is the observational design with self-reported lifestyle information with risk of residual or unmeasured confounding (e.g., genetic liability), and no causal inferences can be made based on this study alone. These findings suggest that diet quality modifies the association between BMI and all-cause mortality in women and men. A healthy diet may, however, not completely counter higher CVD mortality related to obesity.

Prognostic value of Charlson weighted index of comorbidities combined with sequential organ failure assessment score and procalcitonin in patients with sepsis

To assess the prognostic value of Charlson weighted index of comorbidities (WIC) combined with sequential organ failure assessment (SOFA) score and procalcitonin (PCT) in sepsis patients in intensive care unit (ICU). A prospective cohort study was conducted. 118 patients with sepsis admitted to ICU of Sichuan Provincial People's Hospital from July 2015 to June 2018 were enrolled. The clinical data of the patients including gender, age, pathogenic factors, site of infection, underlying diseases and 28-day prognosis were collected, while the WIC score at ICU admission, the acute physiology and chronic health evaluation II (APACHE II) score and SOFA score within 24 hours after ICU admission, serum PCT level within 1 hour after ICU admission were recorded. The patients were divided into survival group and death group according to 28-day prognosis, and the clinical data of patients with different prognosis were compared. Multivariate Logistic regression model was used to analyze the relationship between WIC score, SOFA score, PCT level and the outcomes of patients. The receiver operating characteristic (ROC) curve was drawn to evaluate the value of WIC score, SOFA score, and PCT level for predicting the prognosis of patients with sepsis. In this study, 118 eligible sepsis patients were enrolled, and 94 patients survived at 28 days, and 24 patients died with a 28-day mortality of 20.3%. Compared with the survival group, the patients in the death group were older and had higher APACHE II score, WIC score, SOFA score, and serum PCT levels. Pathogenic factors analysis showed that the proportion of pulmonary infection in the death group was the highest (62.5%), while in the survival group the main cause was multiple injury (36.2%), followed by pulmonary infection (30.9%). Basic diseases analysis showed that the proportions of tumor, type 2 diabetes, chronic lung disease, cerebrovascular disease, chronic kidney disease, chronic liver disease, and chronic cardiac insufficiency in the death group were significantly higher than those in the survival group. The age [odds ratio (OR) = 1.279, 95% confidence interval (95%CI) was 1.065-1.536], APACHE II score (OR = 1.255, 95%CI was 1.083-1.455), WIC score (OR = 1.429, 95%CI was 1.304-1.568), SOFA score (OR = 1.331, 95%CI was 1.456-1.545), and serum PCT level (OR = 1.497, 95%CI was 1.146-1.547) were related to the 28-day prognosis of patients with sepsis, and were independent predictors of 28-day prognosis in patients with sepsis (all P < 0.01). ROC curve analysis showed that the area under ROC curve (AUC) of WIC score, SOFA score, serum PCT level and combined prediction probability was 0.712 (95%CI was 0.588-0.836), 0.801 (95%CI was 0.695-0.908), 0.889 (95%CI was 0.798-0.979), 0.943 (95%CI was 0.884-1.000), respectively, indicating that the accuracy of combined parameters to predict survival outcome was higher than that of any single parameter with the sensitivity of 91.7% and the specificity of 83.0%. WIC score, SOFA score combined with serum PCT level can improve the accuracy of predicting the 28-day prognosis in patients with sepsis.

Left Ventricular Assist Device Implantation Site Volume and 30 Day Readmissions

Introduction Readmissions within 30 days of left ventricular assist device (LVAD) implantation are common, contributing to increased morbidity and cost. The relationship between hospital volume and outcomes after LVAD implantation has not been well established. The purpose of this study was to examine 30-day readmission rates after LVAD implantation, stratified by hospital volume, using the Nationwide Readmissions Database (NRD), an all-payer administrative database. Methods Using the 2014 NRD, we examined 1,311 adults discharged following LVAD implantation in January-November 2014. We identified LVAD implantations based on ICD-9-CM procedure code 37.66 and excluded patients with concurrent ICD-9-CM codes of heart transplantation (37.51 and 33.60). LVAD site volume was determined by counting the number of LVAD implantations from January through December 2014 at each hospital. We then classified patients into site volume quartiles (≤ 23, 24-40, 41-49, and ≥ 50). To determine whether LVAD site volume was independently associated with all-cause 30-day readmission, we conducted multivariable logistic regression accounting for the sample design and adjusting for age, sex, payer status, income quartile, Elixhauser weighted comorbidity index, discharge disposition, pre-LVAD mechanical circulatory support, and length of stay. Results Among 1,311 patients discharged following LVAD implantation, 363 (27%) were readmitted within 30 days. Patients who experienced an LVAD implantation at a hospital in the lowest quartile of LVAD volume were more likely to have higher comorbidity burden, longer index hospitalization length of stay, and have had their implantation at a smaller hospital (bed size Conclusion LVAD site volume was not associated with 30-day readmission. This suggests that regulatory processes in place to ensure high quality LVAD care across sites in the United States have been effective independent of volume.

Perioperative Invasive Vascular Catheterization Associated With Increased Risk of Postoperative Infection in Lumbar Spine Surgery: An Analysis of 114,259 Patient Records.

This is a retrospective cohort study. This study's objective was to determine whether perioperative invasive vascular catheter placement, independent of comorbid conditions, modified the risk of postoperative infection in lumbar spine surgery. Infection is a risk inherent to lumbar spine surgery, with overall postoperative infection rates of 0.86%-8.5%. Patients experiencing postoperative infection have higher rates of mortality, revision surgeries, pseudarthrosis, and worsening pain and disability. Data were collected for patients undergoing lumbar spine surgery between January 2007 and October 2015 with records in the nationwide Humana private insurance database. Patients receiving fusion, laminectomy, and discectomy were followed for 3 months from the date of surgery for surgical site infection (SSI), 6 months for subsequent incision and drainage (I&D), and 1 year for vertebral osteomyelitis (VO). Risk factors investigated included central venous catheter and arterial-line placement. Analysis of 114,259 patient records showed an overall SSI rate of 3.2% within 1 month and 4.5% within 3 months, overall vertebral osteomyelitis rate of 0.82%-0.83% within 1 year, and overall I&D rate of 2.8% within 6 months. Patients receiving a first-time invasive vascular catheter on the day of surgery were more likely to experience SSI within 1 month [risk ratios (RR), 2.5, 95% confidence interval (CI): 2.3-2.7], SSI within 3 months (RR, 2.4; 95% CI: 2.3-2.7), osteomyelitis within 1 year (RR, 4.2-4.3; 95% CI: 3.7-4.5), and undergo an I&D within 6 months (RR, 1.9; 95% CI: 1.8-2.0). These trends were consistent by procedure type and independent of the patient's weighted comorbidity index score (Charlson Comorbidity Index). Perioperative invasive vascular catheterization was significantly associated with an increased the risk of postoperative infections in lumbar spine surgery, independent of a patient's concomitant comorbidities. Therefore, in patients with an indication for invasive catheterization, surgeons should consider risks and benefits of surgery carefully. Level III.

Comparative study between Charlison′s weighted index of comorbidities score, the diagnostic criteria for emergency sepsis score and combination of the two scoring systems to predict the emergency pulmonary infection prognosis

Objective To compare the predictive effect of Charlison's weighted index of comorbidities (WIC), the diagnostic criteria for emergency sepsis (MEDS) and combination of the two scoring systems to predict the emergency pulmonary infection prognosis. Methods A total of 327 patients with pulmonary infection admitted from January 2016 to January 2017 were enrolled in this study whose WIC score, MEDS score and risk stratification were recorded at admission. They were divided into survival group and death group according to the 28 d treatment outcome, the optimal cutoff of WIC score and MEDS score to predict the prognosis were found by ROC curve, and the prediction effect of WIC score, MEDS score, the combined use of both and APACHE Ⅱ to predict the prognosis were compared. Results The mortality of low, middle and high risk of WIC score were 13.7% (29/212), 48.7% (38/78) and 78.4% (29/37) with significant difference (χ2= 82.097, P = 0.000), mortality of low, middle and high risk of MEDS score were 11.3%(23/203), 50.6%(40/77) and 73.3%(33/45) with significant difference (χ2= 145.526, P = 0.000). The WIC scores in survival group and death group were 1.3 ± 0.9 and 2.7 ± 1.1 with significant difference (t = 11.030, P = 0.000). The MEDS score of live group (6.1 ± 4.0) was significantly lower than death group (12.6 ± 4.9) (t = 11.502, P = 0.000). the optimal cutoff values of WIC and MEDS to predict prognosis were 1.7 points, 11.6 points, the ROC curve area between WIC, MEDS score and combined application to predict prognosis were 0.632, 0.798, 0.897, and the sensitivity and accuracy of the combined prediction[93.8% (212/226)/89.9% (294/327)] were significantly higher than those of the individual WIC[72.7% (168/231)/75.2% (246/327)] and MEDS[67.5% (156/232)/72.2% (236/327)] (χ2=0.562-42.594, P 0.05). Conclusions The sensitivity and accuracy of WIC score combined with MEDS score to predict the prognosis of patients with acute lung infection is higher than the individual WIC score and MEDS score, and its prediction effect is more better. Key words: Charlson′s weighted index of comorbidities; Mortality in emergency department sepsis; Emergency; Lung infection; Outcome

Diabetes and the hospitalized patient : A cluster analytic framework for characterizing the role of sex, race and comorbidity from 2006 to 2011.

In the US, one in four adults has two or more chronic conditions; this population accounts for two thirds of healthcare spending. Comorbidity, the presence of multiple simultaneous health conditions in an individual, is increasing in prevalence and has been shown to impact patient outcomes negatively. Comorbidities associated with diabetes are correlated with increased incidence of preventable hospitalizations, longer lengths of stay (LOS), and higher costs. This study focuses on sex and race disparities in outcomes for hospitalized adult patients with and without diabetes. The objective is to characterize the impact of comorbidity burden, measured as the Charlson Weighted Index of Comorbidities (WIC), on outcomes including LOS, total charges, and disposition (specifically, probability of routine discharge home). Data from the National Inpatient Sample (2006-2011) were used to build a cluster-analytic framework which integrates cluster analysis with multivariate and logistic regression methods, for several goals: (i) to evaluate impact of these covariates on outcomes; (ii) to identify the most important comorbidities in the hospitalized population; and (iii) to create a simplified WIC score. Results showed that, although hospitalized women had better outcomes than men, the impact of diabetes was worse for women. Also, non-White patients had longer lengths of stay and higher total charges. Furthermore, the simplified WIC performed equivalently in the generalized linear models predicting standardized total charges and LOS, suggesting that this new score can sufficiently capture the important variability in the data. Our findings underscore the need to evaluate the differential impact of diabetes on physiology and treatment in women and in minorities.

Diagnosis and risk assessment of postoperative complications of gastric cancer in Japan and Korea

Radical surgery of gastric cancer (D2 lymph node dissection) as the standard operation is widely used in clinical practice and satisfactory prognosis can be obtained in patients who receive radical gastrectomy. But surgical invasion can cause high morbidity of complications and mortality. The data of large-scale evidence-based medical clinical trials and large databases in Japan and Korea showed that anastomotic leakage, pancreatic leakage and abdominal abscess were the most common complications after gastrectomy, and the morbidity of complication was about 20% and mortality was about 1%. The risk factors such as elderly, obesity, and comorbidities may increase the morbidity of complications and mortality, and these factors were regarded as poor predictors after operation. Postoperative complications criteria of gastric cancer surgery is mainly used with Clavien-Dindo classification of surgical complications as international standard, and this criteria is also used in Korea. The postoperative complications are evaluated with the Common Terminology Criteria for Adverse Events (CTCAE v4.0) and Japanese Clinical Oncology Group(JCOG) postoperative complications criteria for grading definitions of postoperative complications after gastric surgery in Japan. These classifications of postoperative complications criteria were adopted widely in Japan with large-scale evidence-based medical clinical trials of gastric cancer. PS, ASA, POSSUM, E-PASS, APACHE-II(, Charison weighted index of comorbidities (WIC), Frailty Score was used in predicting postoperative mortality and morbidity in gastric cancer patients. These risk factors were assigned points in scoring systems to objectively evaluate risk of surgery, and surgical operation method was one of the risk factors on the basis of these scoring systems. We can use these scoring systems for choosing reasonable surgical methods and proper perioperative management.

Comparison of predictive value between two kinds of score system in hospital mortality of pneumonia patients

Objective To compare the value in predicting hospital mortality of pneumonia patients between Charlson’s weighted index of comorbidities (WIC) and chronic health score (CHS), in Intensive Care Units (ICU). Methods The clinical data of pneumonia patients collected from September 2013 to September 2014 in ICU of two centers were retrospectively analyzed . The data included sex, age, comorbidites, past history about diseases contracted, presence or absence of severe sepsis. WIC and the acute physiology score (APS), age, chronic health evaluation Ⅱ(APACHEⅡ) score including CHS, APS, age scores, and sepsis related organ failure assessment (SOFA) were calculated. Results Of 293 patients, there are 195 (66.6%) males and 98 (33.4%) females; 197 (67.2%) survivors and 114(33.7%) non-survivors. The average age was (62.5±17.0) years. Compared with survivors, WIC scores were higher in non-survivors. However, the difference in CHS between two groups was not statistically significant. Along with the increase of WIC and CHS score, the patients mortality was increased. The univariate analysis showed that the variables including age, APACHEⅡ score, SOFA, APS, CHS, WIC, and presence or absence of severe sepsis, diabetes, stroke and congestive cardiac failure were related with patientss’ prognosis in 28 days. The univariate logistic regression of CHS (model 1) or WIC (model 2) combine with age, APS, presence or absence of severe sepsis and main comorbidities, such as diabetes, stroke and congestive cardiac failure indicated that risk of death depended significantly on age, APS, CHS, WIC, presence or absence of severe sepsis. The area under the receiver operating characteristics curve (ROC) in predicting mortality was 0.557 95%CI: (0.49-0.623)for CHS, it was lower than the 0.649 95%CI: (0.586-0.712)for WIC (P=0.206, Z=2.315). The AUC of multivariable equations was significantly better than that of APACHEⅡ score (P<0.01). Conclusions The WIC and CHS were independent risk factors for in-hospital mortality of pneumonia patients in ICU. WIC was better than CHS in evaluating comorbidity. Key words: WIC; CHS; APACHE Ⅱ; SOFA; Sepsis; Diabetes; Pneumonia; Outcome

Acute Complications After Adult Spinal Deformity Surgery in Patients Aged 70 Years and Older

This report is a retrospective case series that examined the acute complications of patients aged 70 years and older undergoing spinal deformity surgery that required fusion of at least 6 levels. To determine the acute complications that patients in the eighth decade of their life experience after spinal reconstructive surgery, and how these complication rates compare with other patient populations undergoing similar procedures. As the mean age of the United States population rises, more older patients with painful spinal deformities can be expected. Although there are similar studies in the literature examining acute complications of patients undergoing major spinal deformity surgery, the complication rates of this unique patient population have not been adequately studied. Twenty patients had complete medical records with at least 6 months of follow-up. All the 20 patients underwent instrumented posterior spinal fusions performed by the same surgeon. Comorbidities, weighted comorbidity index, duration, number of hospital days, estimated blood loss, intensive care unit days, American Society of Anesthesiologist score, and intraoperative and postoperative complications were recorded. The mean age of our patient cohort was 76.6 years (range, 70-84 y). Patients had an average of 4 comorbidities and an American Society of Anesthesiologist score of 2.7. Although the group of patients had a large number of comorbidities, their weighted comorbidity index, according to Charlson and colleagues, was fairly low at 1.05 (range, 0-4). All of the patients were fused at least 6 levels, with the average being 10.75 (range, 6-15). Ninety-five percent of patients experienced a complication of some type. Nine major complications occurred in 7 patients. Spinal deformity surgery in patients at any age has associated risks. These risks are believed to increase with age and the complexity of the procedure. Our results show that, although the risks of major complications are significant, the risk is not greater than in a younger population undergoing the similar procedures. We feel that age alone should not be a contraindication for patients in their eighth decade of life who are incapacitated by their painful spinal deformity.

A new clinically applicable age-specific comorbidity index for preoperative risk assessment of ovarian cancer patients

ObjectiveTo develop and validate a new feasible comorbidity index based on self-reported information suited for preoperative risk assessment of ovarian cancer patients. MethodsThe study was based on patient self-reported data from ovarian cancer patients registered in the Danish Gynecological Cancer Database between January 1, 2005 and December 31, 2012. The study population was divided into a development cohort (n=2020) and a validation cohort (n=1975). Age-stratified multivariate Cox regression analyses were conducted to identify comorbidities significantly impacting five-year overall survival in the development cohort, and regression coefficients were used to construct a new weighted comorbidity index. The index was applied to the validation cohort, and its predictive ability in regard to overall and cancer-specific five-year-survival was investigated. Finally, the performance of the new index was compared to that of the Charlson Comorbidity Index. ResultsRegression coefficients of age and five comorbidities (atherosclerotic cardiac disease, chronic obstructive pulmonary disease, diabetes, dementia and hypertension) were included in the new comorbidity index. The validation study found the new index to be significantly associated to both overall survival (HR 1.44, p=0.013) and cancer-specific survival (HR 1.51, p=0.017) in multivariate analyses adjusted for other prognostic factors. The index was a significantly better predictor than the Charlson Comorbidity Index. ConclusionThis new age-specific comorbidity index based on self-reported information is a significant predictor of overall and cancer-specific survival in ovarian cancer. It can be used to quickly identify those ovarian cancer patients requiring special attention in terms of preoperative optimization and postoperative care.

The Prognostic Value of the Charlson's Comorbidity Index in Patients with Prolonged Acute Mechanical Ventilation: A Single Center Experience.

BackgroundThe aim of our study was to evaluate the prognostic value of Charlson's weighted index of comorbidities (WIC) in patients with prolonged acute mechanical ventilation (PAMV, ventilator care ≥96 hours).MethodsWe retrospectively enrolled 299 Korean PAMV patients who were admitted in a medical intensive care unit (ICU) of a university-affiliated tertiary care hospital between 2008 and 2013. Survivors were defined as patients who survived for 60 days after ICU admission.ResultsThe patients' mean age was 65.1±14.1 years and 70.6% were male. The mean ICU and hospital length of stay was 21.9±19.7 and 39.4±39.1 days, respectively. In addition, the 60-day mortality rate after ICU admission was 35.5%. The mean WIC was 2.3±1.8, with significant differences between nonsurvivors and survivors (2.7±2.1 vs. 2.1±1.7, p<0.05). The area under the curve of receiver-operating-characteristics curve for WIC was 0.593 (95% confidence interval [CI], 0.523–0.661; p<0.05). Based on Kaplan-Meier curves of 60-day survival, WIC ≥5 had statistically lower survival than WIC <5 (log-rank test, p<0.05). In a multivariate Cox proportional hazard model, WIC ≥5 was associated with poor prognosis (hazard ratio, 1.901; 95% CI, 1.140–3.171; p<0.05). The mortality rate of patients with WIC ≥5 was 54.2%.ConclusionOur study showed a WIC score ≥5 might be helpful in predicting 60-day mortality in PAMV patients.

The use of Charlson weighted index to evaluate the time of observation in emergency internal observation room

Objective To investigate the role of underlying diseases in predicting the length of stay for observation in emergency department of internal medicine by the Charlson weighted index of comorbidities(WIC) . Methods A single-center retrospective analysis of clinical data of 2 836 patients admitted in emergency observation room of the Beijing Chaoyang Hospital from January 1 to June 30 in 2013 was carried out. The patients were divided into two groups according to the length of observation time: Group A (time of observation ≥72 h, n =1908) and Group B (time of observation <72 h, n =928) . The data of the length of observation time were recorded, and the WIC and the APACHEⅡ score were calculated. Logistic regression analysis was used to determine the independent predictors for 72-hour observation. Receiver operating characteristics (ROC) curve was used to evaluate the value of WIC in predicting 72-hour observation. Results Of 2836 patients, 1176 (41.5%) suffered from respiratory disease, 709 (25.0%) had cardiovascular and cerebrovascular diseases, 423 (14.9%) were contracted digestive system disease, 251 (8.8%) had renal and endocrinology system diseases and 277 (9.8%) had diseases arisen from physicochemical factor and miscellaneous causes. Compared with patients in Group B, the average age, the number of elderly patients residing in apartment exclusively for elderly, the WIC and the APACHEⅡ score were higher in patients in Group A. The one-variable and multi-variable Logistic regression analyses showed that age, the WIC score, the APACHEⅡ score and residing in apartment for elderly people were related with 72-hour observation in emergency observation room. The area under the ROC curve in predicting 72-hour observation was 0.701 for the WIC score, 0.788 for APACHEⅡ score and 0.853 for their combination. Conclusions The WIC scoring system can be a good predicting method for 72-hour observation in patients in emergency observation room.. Key words: Emergency; Charlson weighted index of comorbidities scoring system; Receiver operating characteristics curve; Underlying disease; Logistic regression analysis; Age; Acute physiology and chronic health evaluation; Predicting

Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery.

We evaluated the role of the Charlson age-comorbidity index (CACI), a weighted comorbidity index that reflects cumulative increased likelihood of 1-year mortality, in predicting perioperative outcomes in an emergency general surgery population at a large Canadian teaching hospital. A retrospective chart review of emergency general surgery admissions in 2010 was conducted. Patients who had surgery were identified. Mode of surgery and CACI were recorded, as well as measures of outcome, including 30-day mortality and intensive care unit (ICU) admission. A multivariate stepwise logistic regression model was created to assess the effect of age-adjusted Charlson comorbidity index on postoperative outcomes while controlling for the effect of possible confounders. The prediction ability of CACI for mortality was assessed using receiver operating characteristic analyses considering the area under the curve and its 95% confidence intervals (CIs). Of the 529 admissions to general surgery from the emergency department, 257 patients underwent a surgical intervention. The CACI scores ranged from 0 to 16. We described a total of 11 deaths (4.3%) and 30 ICU admissions (11.7%). CACI was associated with an increased risk of 30-day mortality (adjusted odds ratio,1.39; 95% CI, 1.11-1.73; p = 0.0034). Receiver operating characteristic analysis was consistent with high accuracy of CACI for mortality prediction alone, resulting in area under the curve or c statistic of 0.90 (95% CI, 0.84-0.95). CACI was similar in predicting mortality to a multivariate model. CACI was also found to be associated with ICU admission (adjusted odds ratio, 1.17; 95% CI, 1.01-1.37; p < 0.0382). CACI is not as good a predictor for ICU admission when compared with the multivariate model. We have shown that the CACI is a valid tool for 30-day mortality prediction in the context of emergency general surgery. Prognostic study, level III.

Combination of Weighted index of comorbidities and sepsis-related organ failure assessment score in death risk evaluation of septic patients

To predict the risk of 28- day mortality on septic patients in intensive care unit (ICU) with the combination of the Weighted index of comorbidities (WIC) and sepsis-related organ failure assessment (SOFA) score. The clinical data of adult sever sepsis/ septic shock patients in Department of Emergency Medicine of Chagzeng Hospital and Department of Clinical Care Medicine of Jinan Military General Hospital from October 2011 to February 2013 were analyzed retrospectively. The etiological factor, past history, having sever sepsis or not were recorded. Age score, WIC score, acute physiology and chronic health evaluation II (APACHE II) score and SOFA score were calculated at or 24 hours after admission. The logistic regression was used and the receiver operating characteristic curve (ROC curve) was drawn to calculate the patients' outcome. In 310 enrolled patients, 223 (71.9%) patients survived and 87 (28.1%) died. Univariate analysis showed the P values of the age score, WIC score, APACHE II score and SOFA score. chronic cardiac insufficiency, type 2 diabetes, cerebrovascular disease, tumor, multiple injury, pulmonary infection and having severe sepsis or not were all less tha 0.2. The above 11 variables were put into the multivariate logistic regression equation 1, of which predicted probability was reserved. It revealed that 5 variables were independently associated with 28-day prognosis, of which influence power in descending order were SOFA score [odds ratio (OR)=1.308, 95 % confidence interval (95% CI): 1.158-1.478, P=0.000], having sever sepsis or not (OR=0.206, 95% Cl:0.100-0.424, P=0.000), APACHE II score (OR=1.090, 95% CI:1.021-1.164, P=0.010) WIC score (OR=1.441, 95% CI:1.067-1.947, P=0.017) age score (OR=1.228, 95% CI:1.027-1.468, P=0.024), the Wals were 18.554, 18.369, 6.725, 5.662, 5.067, respectively. The 3 variables, age score, WIC score and SOFA score, were brought into the multivariate logistic regression equation 2, of which predicted probability was reserved too. It revealed that age score (OR=1.330, 95 % CI: 1.145-1.546, P=0.000), WIC score (OR=1.496, 95% CI: 1.145-1.546, P=000) and SOFA score (OR=1.429, 95% CI: 1.303-1.567, P=0.000), were independently associated with the septic patients’ 28-day prognosis. There was no significant difference in the area under receiver operating characteristics curve (AUC) between the SOFA score and APACHE II score (0.784 vs. 0.780, Z=0.014, P=0.989). However, compared with APACHE II score, the AUC of equation 1 (0.888) and 2 (0.851) were much more (Z=4.333, P= 0.000; Z= 2.669, P= 0.008). The sensitivity of 28-day prognosis 28-day prognosis by WIC score was improved greatly with the combination of SOFA score and age score.

Charlson's weighted index of comorbidities in assessing prognosis of septic patients

Objective To investigate the value of Charlson's weighted index of comorbidities(WIC) in predicting the prognosis of patients with sepsis. MethodsThe clinical data of 234 septic patients in the last three years were retrospectively analyzed.The scores of WIC and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) were calculated.The patients were divided into two groups according to death or survival outcome 28 days later,and the value of WIC score in predicting prognosis was analyzed.ResultsIt was found that 77(32.9%) of the 234 patients died.Increasing WIC score was associated with increased mortality.Multiple logistic regression analysis revealed that WIC was a risk factor of prognosis of septic patients(OR =1.434,95% CI:1.097-1.875,P =0.008).The areas under the ROC curves in predicting the mortality of the septic patients were 0.670(0.591-0.748) for the WIC score,0.770(0.703-0.837) for APACHEⅡ score and 0.821(0.757-0.885) for the combination of both.ConclusionWIC score can satisfactorily predict the influence of underlying diseases on the prognosis of septic patients.

Weighted index of comorbidities evaluates the impact of underlying diseases on hospital mortality of pneumonia patients

Objective To estimate the validity of Charlson' s weighted index of comorbidities (WIC) used to predicting 28-day mortality among ICU pneumonia patients with underlying diseases.Methods Aretrospective analysis of 160 adult patients with pneumonia admitted to a multi-discipline ICU of Shanghai Changzheng hospital between October 2010 and February 2012 was carried out.Clinical data were collected including age,gender,community acquired pneumonia (CAP) or hospital acquired pneumonia (HAP),underlying diseases,severity-of-sepsis,and 28-day mortality.WIC scores,acute physiology and chronic health evaluation (APACHE) Ⅱ,and sepsis related organ failure assessment (SOFA) were assessed within the first 24 hours after admission.Logistic regression analyses were used to evaluate the predictors for outcome.The receiver operating characteristic curve (ROC) was used to compare the performance of these scores between different methods.Results Of 160 enrolled patients,76 (48.8％) were CAP,82 (51.2％) HAP,and 106 (66.3％) male,54 (33.7％) female,and 99 (61.9％) patients survived and 61 (38.1％) died.The average age was (62.4 ± 17.3) years old.Compared with survivors,WIC,APACHE Ⅱ and SOFA scores were significantly higher in death group (P ＜ 0.05).The multivariate logistic regression revealed that risk of death depends predominantly on age (OR =1.049,95％ CI:1.011-1.088,P =0.011),WIC (OR =1.725,95％ CI:1.194-2.492,P =0.004),APACHE Ⅱ score (OR =1.175,95％CI:1.058-1.305,P =0.003),SOFA score (OR =1.277,95％ CI:1.048-1.556,P =0.015),presence of ARDS (OR =0.081,95％ CI:0.008-0.829,P =0.034),and complicated with severe sepsis (OR =0.149,95％ CI:0.232-0.622,P =0.004).The area under the receiver operating characteristics curve in predicting mortality was 0.639 (0.547-0.730) for the WIC,0.782 (0.709-0.856) for APACHE Ⅱ score,0.79 (0.714-0.866) for SOFA score and 0.842 (0.777-0.907) for the merger of three.Conclusions In pneumonia patients of ICU,WIC is a useful approach to predicting 28-day mortality,and the risk of death significantly depends on co-morbidities. Key words: WIC; APACHE Ⅱ score; SOFA score; Pneumonia; Outcome

Health-related quality of life and comorbidity among older women veterans in the United States

This paper examines the predictors of quality of life among older women (≥65years of age) veterans in the United States focusing on the effect of comorbidity on health-related quality of life (HRQOL). Data from the National Survey of Women Veterans, a cross-sectional nationally representative population-based, stratified random sample of women veterans, were used with an analytic sample size of 1,379 older women veterans. The SF12 physical and mental composite scores (PCS and MCS) were used as outcome measures, and a weighted comorbidity index was used as a covariate. Older women veterans who are married, employed, with higher income, and higher education have better physical health (PCS). For mental health, education is positively correlated, whereas depression and posttraumatic stress disorder are negatively correlated with MCS. After adjusting for socio-demographic, mental health, and chronic health indicators, the results showed that SF12 PCS varied by VA use status for each level of Seattle Index of Comorbidity. The same pattern was not found for MCS. For each level of comorbidity, VA users have worse HRQOL which might suggest that case mix adjustments comparing VA users and non-VA users must take into account more than comorbidity alone.