Pre-existing Comorbidity Burden and Patient Perceived Stroke Impact

Background Pre-existing comorbidities can compromise recovery post-stroke. However, the association between comorbidity burden and patient-rated perceived impact has not been systematically investigated. To date, only observer-rated outcome measures of function, disability, and dependence have been used, despite the complexity of the impact of stroke on an individual. Aim Our aim was to explore the association between comorbidity burden and patient-rated perceived impact and overall recovery, within the first-year post-stroke, after adjusting for stroke severity, age, and sex. Methods The sample comprised 177 stroke survivors from 18 hospitals throughout Australia and New Zealand. Comorbidity burden was calculated using the Charlson Comorbidity Index. Perceived impact and recovery were measured by the Stroke Impact Scale index and Stroke Impact Scale overall recovery scale. Quantile regression models were applied to investigate the association between comorbidity burden and perceived impact and recovery. Results Significant negative associations between the Charlson Comorbidity Index and the Stroke Impact Scale index were found at three months. At the .25 quantile, a one-point increase on the Charlson Comorbidity Index was associated with 6.80-points decrease on the Stroke Impact Scale index (95%CI: −11.26, −2.34; p = .003). At the median and .75 quantile, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 3.58-points decrease (95%CI: −5.62, −1.54; p = .001) and 1.76-points decrease (95%CI: −2.80, −0.73; p = .001) on the Stroke Impact Scale index. At 12 months, at the .25 and .75 quantiles, a one-point increase on the Charlson Comorbidity Index was associated, respectively, with 6.47-points decrease (95%CI: −11.05, −1.89; p = .006) and 1.26-points decrease (95%CI: −2.11, −0.42; p = .004) on the Stroke Impact Scale index. For the Stroke Impact Scale overall recovery measure, significant negative associations were found only at the median at three months and at the .75 quantile at 12 months. Conclusion Comorbidity burden is independently associated with patient-rated perceived impact within the first-year post-stroke. The addition of patient-rated impact measures in personalized rehabilitation may enhance the use of conventional observer-rated outcome measures.

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A data-driven medication score predicts 10-year mortality among aging adults

Scientific Reports ◽

10.1038/s41598-020-72045-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Paavo Häppölä ◽

Aki S. Havulinna ◽

Tõnis Tasa ◽

Nina J. Mars ◽

Markus Perola ◽

...

Keyword(s):

Charlson Comorbidity Index ◽

The Elderly ◽

Data Driven ◽

Mortality Data ◽

Point Increase ◽

Medication Score ◽

Health Differences ◽

Comorbidity Index ◽

Aging Adults ◽

Aging Societies

Abstract Health differences among the elderly and the role of medical treatments are topical issues in aging societies. We demonstrate the use of modern statistical learning methods to develop a data-driven health measure based on 21 years of pharmacy purchase and mortality data of 12,047 aging individuals. The resulting score was validated with 33,616 individuals from two fully independent datasets and it is strongly associated with all-cause mortality (HR 1.18 per point increase in score; 95% CI 1.14–1.22; p = 2.25e−16). When combined with Charlson comorbidity index, individuals with elevated medication score and comorbidity index had over six times higher risk (HR 6.30; 95% CI 3.84–10.3; AUC = 0.802) compared to individuals with a protective score profile. Alone, the medication score performs similarly to the Charlson comorbidity index and is associated with polygenic risk for coronary heart disease and type 2 diabetes.

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28. Utilizing the Charleston Comorbidity Index as an Independent Predictor for Outcomes in SARS-Cov-2 Positive Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.028 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S20-S20

Author(s):

Irene Riestra Guiance ◽

Steven Char ◽

Ernesto Robalino Gonzaga ◽

Isabel Riestra ◽

Minh Q Ho

Keyword(s):

Hospital Mortality ◽

Scoring System ◽

Youden Index ◽

Multinomial Regression ◽

Optimal Point ◽

Severe Condition ◽

Icu Admission ◽

Point Increase ◽

Comorbidity Burden ◽

Comorbidity Index

Abstract Background Since COVID-19 was declared a pandemic, it has seemed that the virus is nondiscriminatory causing 3.73 million deaths worldwide. The Charleston Comorbidity Index (CCI) is a scoring system predicting the one-year mortality for patients with a range of comorbid conditions and is widely used as a predictor of prognosis and survival for a range of pathologies. This study aims to assess if there is an impact of comorbidity burden on COVID-19 patients by utilizing their CCI score. Charleston Comorbidity Index Score Scoring system for Charleston Comorbidity Index (CCI). Plus 1 point for every decade age 50 years and over, maximum 4 points. Higher scores indicate a more severe condition and consequently, a worse prognosis. Methods Multicenter, retrospective review of patients diagnosed with COVID-19 from January 2020 to September 2020 throughout the HCA Healthcare system. CCI scores for all COVID-19 positive patients were calculated and logistic regression analysis was performed to predict hospitalization and ICU admission by CCI controlling for age, sex and race. A multinomial regression model was also performed to predict discharge status by CCI controlling for age, sex and race. ROC curves to indicate the CCI cut-off point for each outcome (hospitalization, ICU admission and mortality) was performed, and Youden’s Index was used to identify the optimal point. Results In the study timeframe, 92,800 patients were diagnosed with COVID-19 and of those, 48,270 were hospitalized. A one-point increase in CCI was associated with higher odds of hospitalization [OR 1.718; 95% CI 1.696-1.74]. The threshold for significance to predict hospitalization was a CCI of 1.5 (AUC 0.804, Youden Index 0.48) with a specificity (73%) and sensitivity (75%). A one-point increase in CCI was associated with 1.444 higher odds of an ICU admission (95% CI 1.134-1.155). A one-point increase in CCI significantly increased the odds of discharge to hospice compared to any discharge other than hospice [OR 1.162; 95% CI 1.142-1.182]). A one-point increase in CCI score was associated with 1.188 higher odds of in-hospital mortality (95% CI, 1.173-1.203) with a CCI threshold of 3.5 having the highest specificity (50.9%) and sensitivity (79.9%) to predict mortality outcome (AUC 0.704, Youden Index 0.31). Conclusion In conclusion CCI score is an adequate predictor of hospitalization and in-hospital mortality but less so in predicting ICU admission in COVID-19 positive patients. Disclosures All Authors: No reported disclosures

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Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia

PLoS ONE ◽

10.1371/journal.pone.0260169 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0260169

Author(s):

Jorge Enrique Machado-Alba ◽

Luis Fernando Valladales-Restrepo ◽

Manuel Enrique Machado-Duque ◽

Andrés Gaviria-Mendoza ◽

Nicolás Sánchez-Ramírez ◽

...

Keyword(s):

Intensive Care ◽

Charlson Comorbidity Index ◽

Severe Pneumonia ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Factors Associated ◽

Intervention Measures ◽

Point Increase ◽

Comorbidity Index ◽

Patient Prognosis

Introduction Coronavirus disease 2019 (COVID-19) has affected millions of people worldwide, and several sociodemographic variables, comorbidities and care variables have been associated with complications and mortality. Objective To identify the factors associated with admission to intensive care units (ICUs) and mortality in patients with COVID-19 from 4 clinics in Colombia. Methods This was a follow-up study of a cohort of patients diagnosed with COVID-19 between March and August 2020. Sociodemographic, clinical (Charlson comorbidity index and NEWS 2 score) and pharmacological variables were identified. Multivariate analyses were performed to identify variables associated with the risk of admission to the ICU and death (p<0.05). Results A total of 780 patients were analyzed, with a median age of 57.0 years; 61.2% were male. On admission, 54.9% were classified as severely ill, 65.3% were diagnosed with acute respiratory distress syndrome, 32.4% were admitted to the ICU, and 26.0% died. The factors associated with a greater likelihood of ICU admission were severe pneumonia (OR: 9.86; 95%CI:5.99–16.23), each 1-point increase in the NEWS 2 score (OR:1.09; 95%CI:1.002–1.19), history of ischemic heart disease (OR:3.24; 95%CI:1.16–9.00), and chronic obstructive pulmonary disease (OR:2.07; 95%CI:1.09–3.90). The risk of dying increased in those older than 65 years (OR:3.08; 95%CI:1.66–5.71), in patients with acute renal failure (OR:6.96; 95%CI:4.41–11.78), admitted to the ICU (OR:6.31; 95%CI:3.63–10.95), and for each 1-point increase in the Charlson comorbidity index (OR:1.16; 95%CI:1.002–1.35). Conclusions Factors related to increasing the probability of requiring ICU care or dying in patients with COVID-19 were identified, facilitating the development of anticipatory intervention measures that favor comprehensive care and improve patient prognosis.

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The Utility of the Charlson Comorbidity Index in Predicting Use of Treatment and Survival in Older Lymphoma Patients

Blood ◽

10.1182/blood.v128.22.2405.2405 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2405-2405

Author(s):

Gunjan L. Shah ◽

Aaron Winn ◽

Anita J Kumar ◽

Miguel-Angel Perales ◽

Pei-Jung Lin ◽

...

Keyword(s):

Charlson Comorbidity Index ◽

Conflicts Of Interest ◽

Cell Lymphoma ◽

Prognostic Significance ◽

B Cell Lymphoma ◽

Chronic Obstructive ◽

Median Income ◽

Clinical Patient ◽

Comorbidity Burden ◽

Comorbidity Index

Abstract Introduction: The Charlson Comorbidity Index (CCI) has been adapted to claims-based analyses to assess comorbidity burden in cancer patients (primarily with solid tumors). We aimed to validate the CCI's prognostic significance in older lymphoma patients. Methods: Using data from the Surveillance, Epidemiology, and End Results (SEER) Program linked with Medicare claims, we identified lymphoma patients 66 years and older using ICD-O codes from 1995-2010. We measured comorbidity burden in the year prior to patients' lymphoma diagnosis by calculating the Deyo/Klabunde-modified CCI scores using diagnosis codes in the claims (J Clin Epidemiol 2000). We estimated the unadjusted and adjusted association of CCI scores and demographic factors with overall survival (OS) and chemotherapy use at 6 months using a modified Poisson and logistic regression models. Results: We identified 8,961 newly diagnosed patients with follicular lymphoma (FL), 19,997 diffuse large B-cell lymphoma (DLBCL), and 2,171 mantle cell lymphoma (MCL), of which 54%, 65%, and 63% received chemotherapy within 6 months of their cancer diagnoses, respectively. Age, gender, CCI, marital status, race, median income, and stage were significantly different between patients who received therapy and those who did not. Average CCI was lower in those who were treated vs not [FL 0.76 vs 0.82 (p=0.06), DLBCL 0.84 vs 1.12 (p<0.001), and MCL 0.83 vs 1 (p=0.04)]. The CCI was predictive of 2 year-OS for FL, DLBCL, & MCL with a risk ratio of 0.91 (95%CI 0.89-0.93), 0.83 (0.8-0.86) and 0.89 (0.82-0.97) for CCI 1-2 vs 0; 0.72 (0.67-0.77), 0.58 (0.54- 0.62) and 0.68 (0.57-0.81) for CCI 3-5 vs 0; and 0.54 (0.34- 0.87), 0.37 (0.24-0.57) and 0.83 (0.45-1.55) for CCI 6+ vs 0, respectively (Figure 1A,B,C). For all three subtypes, in addition to CCI, older age, female gender, living in a more rural area, race other than Caucasian, higher stage, and not receiving chemotherapy were also significantly associated with worse OS in the adjusted analysis. Within the CCI, the majority of the disease categories (myocardial infarction, peripheral vascular disease, chronic obstructive pulmonary disease, dementia, diabetes, diabetes with sequelae, chronic renal failure, moderate/severe liver disease, and cirrhosis) were more frequent in patients who did not receive treatment, particularly for DLBCL (Table 1). However, the overall predictive ability of our model for identifying patients who would receive chemotherapy was low (c-statistic =0.707). Conclusion: In this first ever analysis of the CCI in lymphoma patients, we are able to confirm the utility of this scoring system in a new population. The majority of patients with three common lymphoma histologies captured in SEER-Medicare started treatment within 6 months of diagnosis. Comorbidity burden at diagnosis, measured by the Deyo/ Klabunde -modified CCI, is prognostic of OS for FL, DLBCL, and MCL. However, CCI along with other demographic non-clinical patient characteristics do not predict treatment initiation among older adults with lymphoma. Further claims analyses evaluating survival can include the CCI as an important variable. Disclosures No relevant conflicts of interest to declare.

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The impact of a patient-directed activity program on functional outcomes and activity participation after stroke during inpatient rehabilitation—a randomized controlled trial

Clinical Rehabilitation ◽

10.1177/0269215519901153 ◽

2020 ◽

Vol 34 (4) ◽

pp. 504-514

Author(s):

Chad Swank ◽

Molly Trammell ◽

Librada Callender ◽

Monica Bennett ◽

Kara Patterson ◽

...

Keyword(s):

Physical Activity ◽

Randomized Controlled Trial ◽

Functional Outcomes ◽

Controlled Trial ◽

Inpatient Rehabilitation ◽

Post Stroke ◽

Randomized Controlled ◽

Activity Program ◽

Stroke Impact Scale ◽

Impact Scale

Objective: Individuals post stroke are inactive, even during rehabilitation, contributing to ongoing disability and risk of secondary health conditions. Our aims were to (1) conduct a randomized controlled trial to examine the efficacy of a “Patient-Directed Activity Program” on functional outcomes in people post stroke during inpatient rehabilitation and (2) examine differences three months post inpatient rehabilitation discharge. Design: Randomized control trial. Setting: Inpatient rehabilitation facility. Subjects: Patients admitted to inpatient rehabilitation post stroke. Interventions: Patient-Directed Activity Program (PDAP) or control (usual care only). Both groups underwent control (three hours of therapy/day), while PDAP participants were prescribed two additional 30-minute activity sessions/day. Main measures: Outcomes (Stroke Rehabilitation Assessment of Movement Measure, Functional Independence Measure, balance, physical activity, Stroke Impact Scale) were collected at admission and discharge from inpatient rehabilitation and three-month follow-up. Results: Seventy-three patients (PDAP ( n = 37); control ( n = 36)) were included in the primary analysis. Patients in PDAP completed a total of 23.1 ± 16.5 sessions (10.7 ± 8.5 upper extremity; 12.4 ± 8.6 lower extremity) during inpatient rehabilitation. No differences were observed between groups at discharge in functional measures. PDAP completed significantly more steps/day (PDAP = 657.70 ± 655.82, control = 396.17 ± 419.65; P = 0.022). The Stroke Impact Scale showed significantly better memory and thinking (PDAP = 86.2 ± 11.4, control = 80.8 ± 16.7; P = 0.049), communication (PDAP = 93.6 ± 8.3, control = 89.6 ± 12.4; P = 0.042), mobility (PDAP = 62.2 ± 22.5, control = 53.8 ± 21.8; P = 0.038), and overall recovery from stroke (PDAP = 62.1 ± 19.1, control = 52.2 ± 18.7; P = 0.038) for PDAP compared to control. At three months post discharge, PDAP ( n = 11) completed significantly greater physical activity ( P = 0.014; 3586.5 ± 3468.5 steps/day) compared to control ( n = 10; 1760.9 ± 2346.3 steps/day). Conclusion: Functional outcome improvement was comparable between groups; however, PDAP participants completed more steps and perceived greater recovery.

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AB0887-HPR CHARLSON COMORBIDITY INDEX (CCI) IN RHEUMATOID ARTHRITIS: CLASSIFICATION AND CORRELATIONS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1103 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1467.1-1467

Author(s):

C. Flourou ◽

S. Psarelis ◽

A. Tofarides ◽

E. Papanicolaou ◽

G. Papazisis

Keyword(s):

Charlson Comorbidity Index ◽

Outpatient Service ◽

Biologic Dmards ◽

Maximum Score ◽

Real World Setting ◽

Comorbidity Burden ◽

Comorbidity Index ◽

Multivariable Analyses ◽

Severity Of The Disease

Background:Charlson Comorbidity Index[1] is a tool including age and chronic diseases assessing the comorbidity burden. The age and the comorbidity burden in RA patients determine the morbidity and mortality.Objectives:To assess and classification of CCI in RA patients with usage of the health-care system (outpatient clinics) in a real-world setting.Methods:327 patients with RA from a large outpatient service of a central hospital were retrospectively reviewed. Demographic characteristics, treatment for RA and comorbidities were recorded. Charlson Comorbidity Index (CCI) was measured and classified as low, intermediate and high score for 1-2, 3-4 and >=5 points, respectively. Its correlation with polypharmacy and necessity of biologic DMARDs was studied. Univariable and multivariable analyses were performed.Results:Data from 327 RA patients (75,8% females, 24,2%males) with a mean±SD age of 63±11,8 years and disease duration 113±63 months, were recorded.CCI was 3±1,2 points (mean±SD) and maximum score was observed at 7 points. High score (>=5points) was observed at 9,2% and in the majority the score was intermediate (3-4points) at 55%. All the RA patients with high score fulfilled the criteria of polypharmacy. Patients with high score had 9,7 times more probability of polypharmacy than the patients with low score (p=0.09, 1.4-2.5 95%CI).70 patients were treated with biologic-DMARDs (21,7%), in the majority with TNFa inhibitors (16,5%). In RA patients receiving biologic-DMARDs was observed low or intermediate score of CCI. Τhe most likely explanation is the severity of the disease that predominated, its complications and the possible overlap with other conditions.Conclusion:The majority of RA patients had intermediate score of CCI. In patients with high score-meaning more comorbidities- polypharmacy was observed completely. Patients receiving biologic-DMARDs characterized with less comorbidities.References:[1]Charlson E M et al. A new method of classifying prognostic comorbidity in longitudinal studies:development and validation. J Chronic Dis. 1987;40(5):373-83.Disclosure of Interests:None declared

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Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia

Healthcare ◽

10.3390/healthcare9070783 ◽

2021 ◽

Vol 9 (7) ◽

pp. 783

Author(s):

Mei-Chi Hsu ◽

Shang-Chi Lee ◽

Wen-Chen Ouyang

Keyword(s):

Elderly Patients ◽

Charlson Comorbidity Index ◽

Survival Rates ◽

Age Groups ◽

Population Based ◽

Increased Risk ◽

Comorbidity Burden ◽

Comorbidity Index ◽

The Mean ◽

First Admission

Objectives: Comorbid illness burden signifies a poor prognosis in schizophrenia. The aims of this study were to estimate the severity of comorbidities in elderly patients with schizophrenia, determine risk factors associated with mortality, and establish a reliable nomogram for predicting 1-, 3- and 5-year mortality and survival. Methods: This population-based study rigorously selected schizophrenia patients (≥65 years) having their first admission due to schizophrenia during the study period (2000–2013). Comorbidity was scored using the updated Charlson Comorbidity Index (CCI). Results: This study comprised 3827 subjects. The mean stay of first admission due to schizophrenia was 26 days. Mean numbers of schizophrenia and non-schizophrenia-related hospitalization (not including the first admission) were 1.80 and 3.58, respectively. Mean ages at death were 73.50, 82.14 and 89.32 years old, and the mean times from first admission to death were 4.24, 3.33, and 1.87 years in three different age groups, respectively. Nearly 30% were diagnosed with ≥3 comorbidities. The most frequent comorbidities were dementia, chronic pulmonary disease and diabetes. The estimated 1-, 3- and 5-year survival rates were 90%, 70%, and 64%, respectively. Schizophrenia patients with comorbid diseases are at increased risk of hospitalization and mortality (p < 0.05). Conclusion: The nomogram, composed of age, sex, the severity of comorbidity burden, and working type could be applied to predict mortality risk in the extremely fragile patients.

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Daily Life Upper Limb Activity for Patients with Match and Mismatch between Observed Function and Perceived Activity in the Chronic Phase Post Stroke

Sensors ◽

10.3390/s21175917 ◽

2021 ◽

Vol 21 (17) ◽

pp. 5917

Author(s):

Bea Essers ◽

Marjan Coremans ◽

Janne Veerbeek ◽

Andreas Luft ◽

Geert Verheyden

Keyword(s):

Motor Function ◽

Upper Limb ◽

Clinical Characteristics ◽

Daily Life ◽

Chronic Phase ◽

Chronic Stroke ◽

Good Match ◽

Post Stroke ◽

Stroke Impact Scale ◽

Impact Scale

We investigated actual daily life upper limb (UL) activity in relation to observed UL motor function and perceived UL activity in chronic stroke in order to better understand and improve UL activity in daily life. In 60 patients, we collected (1) observed UL motor function (Fugl-Meyer Assessment (FMA-UE)), (2) perceived UL activity (hand subscale of the Stroke Impact Scale (SIS-Hand)), and (3) daily life UL activity (bilateral wrist-worn accelerometers for 72 h) data. Data were compared between two groups of interest, namely (1) good observed (FMA-UE >50) function and good perceived (SIS-Hand >75) activity (good match, n = 16) and (2) good observed function but low perceived (SIS-Hand ≤75) activity (mismatch, n = 15) with Mann–Whitney U analysis. The mismatch group only differed from the good match group in perceived UL activity (median (Q1–Q3) = 50 (30–70) versus 93 (85–100); p < 0.001). Despite similar observed UL motor function and other clinical characteristics, the affected UL in the mismatch group was less active in daily life compared to the good match group (p = 0.013), and the contribution of the affected UL compared to the unaffected UL for each second of activity (magnitude ratio) was lower (p = 0.022). We conclude that people with chronic stroke with low perceived UL activity indeed tend to use their affected UL less in daily life despite good observed UL motor function.

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Discriminant Validity of the Stroke Impact Scale

Stroke ◽

10.1161/str.32.suppl_1.361-c ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 361-361

Author(s):

Sue-Min Lai Dr ◽

Stephanie Studenski Dr ◽

Pamela W Duncan Dr ◽

Subashan Perera Dr

Keyword(s):

Quality Of Life ◽

Discriminant Validity ◽

Community Dwelling ◽

Elderly Subjects ◽

Stroke Patients ◽

P Values ◽

Post Stroke ◽

Stroke Impact Scale ◽

Impact Scale

P123 Purpose: The purpose of this study was to determine the discriminant validity of the Stroke Impact Scale (SIS) by comparing function and quality of life in stroke patients to assessments from stroke-free community dwelling elderly. Methods: The SIS was administered at 90 to 120 days post-stroke to subjects who participated in the Kansas City Stroke Registry (KCSR). The same impact scale was also administered cross-sectionally to community dwelling elderly who were recruited from primary care clinics for participation in an ongoing prospective study of health and function (Merck). All subjects were queried for responses to 64 items of the SIS including eight domains: strength, memory and thinking, emotion, communication, ADL/IADL, mobility, upper extremity, and social participation. Regression analyses were used to examine differences between stroke patients and stroke-free elderly in each of the eight SIS domains while controlling for demographics and comorbidities. Results: One hundred and sixty KCSR subjects and two hundred and forty-three subjects from the Merck study were included in the present analysis. The mean ages were 73±10.1 and 74±5.1, respectively. Gender and race were similar in both groups. The 90-days post-stroke mean Barthel ADL was 80±23 in the stroke patients. Mean scores of all 8 SIS domains were significantly lower in stroke patients than those in the stroke-free community dwelling elderly even after controlling for differences in age and comorbidities (all p values < 0.0001). Mean scores of the 7 SIS domains (except strength), even in stroke patients who had Barthel ADL > 90 at 90-days post-stroke, remained lower than those in the stroke-free community dwelling elderly (p values < 0.01). Conclusion: The SIS was able to discriminate well between stroke patients with disability and stroke-free elderly subjects. Patients who had recovered basic ADLs continued to have residual disability and impaired quality of life when compared to non-stroke patients.

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