Validity of the Medication-Based Disease Burden Index Compared with the Charlson Comorbidity Index and the Cumulative Illness Rating Scale for Geriatrics

Drugs & Aging ◽  
2011 ◽  
Vol 28 (12) ◽  
pp. 1007-1014 ◽  
Author(s):  
Yichayaou Beloosesky ◽  
Avraham Weiss ◽  
Nariman Mansur
Keyword(s):  
Charlson Comorbidity Index ◽  
Disease Burden ◽  
Rating Scale ◽  
Comorbidity Index

Risikoabschätzung einer akuten Exazerbation bei COPD-Patienten im Rahmen einer pneumologischen Anschluss-Rehabilitation anhand der Prävalenz und Schwergradausprägung von Komorbiditäten

Pneumologie ◽  
2021 ◽  
Author(s):  
P. Luu ◽  
S. Tulka ◽  
S. Knippschild ◽  
W. Windisch ◽  
M. Spielmanns
Keyword(s):  
Receiver Operating Characteristic ◽  
Charlson Comorbidity Index ◽  
Operating Characteristic ◽  
Rating Scale ◽  
Area Under The Curve ◽  
Sensitivität Und Spezifität ◽  
Comorbidity Index ◽  
Receiver Operating

Zusammenfassung Einleitung Akute COPD-Exazerbationen (AECOPD) im Rahmen einer pneumologischen Rehabilitation (PR) sind häufige und gefährliche Komplikationen. Neben Einschränkungen der Lebensqualität führen sie zu einem Unterbrechung der PR und gefährden den PR-Erfolg. Eine Abhängigkeit zwischen dem Krankheitsstatus und einem erhöhten Risiko für eine AECOPD ist beschrieben. Dabei stellt sich die Frage, ob der Charlson Comorbidity Index (CCI) oder die Cumulative Illness Rating Scale (CIRS) dafür geeignet sind, besonders exazerbationsgefährdete COPD-Patienten in der PR im Vorfeld zu detektieren. Patienten und Methoden In einer retrospektiven Untersuchung wurden die Daten von COPD-Patienten, welche im Jahr 2018 eine PR erhielten, analysiert. Primärer Endpunkt der Untersuchung war die Punktzahl im CCI. Alle Daten wurden dem Klinikinformationssystem Phönix entnommen und COPD-Exazerbationen erfasst. Die laut Fallzahlplanung benötigten 44 Patienten wurden zufällig (mittels Zufallsliste für jede Gruppe) aus diesem Datenpool rekrutiert: 22 Patienten mit und 22 ohne Exazerbation während der PR. CCI und CIRS wurden für die eingeschlossenen Fälle für beide Gruppen bestimmt. Die Auswertung des primären Endpunktes (CCI) erfolgte durch den Gruppenvergleich der arithmetischen Mittel und der Signifikanzprüfung (Welch-Tests). Weitere statistische Lage- und Streuungsmaße wurden ergänzt (Median, Quartile, Standardabweichung).Zusätzlich wurde mittels Receiver Operating Characteristic (ROC)-Analyse sowohl für den CCI als auch für den CIRS ein optimaler Cutpoint zur Diskriminierung in AECOPD- und Nicht-AECOPD-Patienten gesucht. Ergebnisse 244 COPD-Patienten erhielten eine stationäre PR von durchschnittlich 21 Tagen, wovon 59 (24 %) während der PR eine behandlungspflichtige AECOPD erlitten. Die ausgewählten 22 Patienten mit einer AECOPD hatten einen mittleren CCI von 6,77 (SD: 1,97) und die 22 Patienten ohne AECOPD von 4,32 (SD: 1,17). Die Differenz von –2,45 war zu einem Signifikanzniveau von 5 % statistisch signifikant (p < 0,001; 95 %-KI: [–3,45 ; –1,46]). Die ROC-Analyse zeigte einen optimalen Cutpoint für den CCI bei 6 mit einer Sensitivität zur Feststellung einer AECOPD von 81,8 % und einer Spezifität von 86.,4 % mit einem Wert der AUC (area under the curve) von 0,87. Der optimale Cutpoint für den CIRS war 19 mit einer Sensitivität von 50 %, einer Spezifität von 77,2 % und einer AUC von 0,65. Schlussfolgerung COPD-Patienten mit einer akuten Exazerbation während der pneumologischen Rehabilitation haben einen höheren CCI. Mithilfe des CCI lässt sich mit einer hohen Sensitivität und Spezifität das Risiko einer AECOPD von COPD-Patienten im Rahmen eines stationären PR-Programms einschätzen.

scholarly journals Μελέτη συσχέτισης προεγχειρητικών και διεγχειρητικών δεικτών συννοσηρότητας σε ουρολογικές επεμβάσεις

2021 ◽  
Author(s):  
Ειρήνη Σαρρή
Keyword(s):  
Apgar Score ◽  
Charlson Comorbidity Index ◽  
Rating Scale ◽  
Comorbidity Index ◽  
American Society ◽  
American Society Of Anesthesiologists

Συσχέτιση των προεγχειρητικών δεικτών συνοδού νοσηρότητας με δείκτες περι- και μετεγχειρητικού κινδύνου σε ασθενείς που υποβάλλονται σε ουρολογικές επεμβάσεις. Εισαγωγή και σκοπός: Η συχνότητα της μετεγχειρητικής νοσηρότητας και θνητότητας χρησιμοποιείται σαν ποιοτικός δείκτης των υπηρεσιών υγείας. Τα μεγέθη προβλέπονται με δείκτες όπως ο POSSUM, ενώ ο μετεγχειρητικός κίνδυνος μπορεί να υπολογισθεί με βάση το χειρουργικό Apgar score. Η προεγχειρητική συνοδός νοσηρότητα μπορεί όμως να επηρρεάζει τους περιεγχειρητικούς δείκτες και συνακόλουθα, την νοσηρότητα και θνησιμότητα. Σκοπός της μελέτης ήταν η εκτίμηση της συσχέτισης της προεγχειρητικής συνοδού νοσηρότητας και άλλων προεγχειρητικών δεικτών με δείκτες περι- και μετεγχειρητικού κινδύνου. Υλικό και Μέθοδοι: Στη μελέτη συμπεριελήφθησαν 100 ασθενείς που υπεβλήθησαν σε μείζονες, ανοικτές, ουρολογικές επεμβάσεις (39 νεφρεκτομές, 43 ριζικές προστατεκτομές, 18 ριζικές κυστεκτομές). Η προεγχειρητική συνοδός νοσηρότητα υπολογίσθηκε με τους δείκτες: Charlson Comorbidity Index (CCI), age-adjusted CCI (AA-CCI), Cumulative Illness Rating Scale (CIRS), Index of Co-Existent Diseases (ICED). Ο προεγχειρητικός κίνδυνος εκτιμήθηκε με τον δείκτη ASA (American Society of Anesthesiologists) και η προεγχειρητική λειτουργική κατάσταση με τα μεταβολικά ισοδύναμα (MET). Οι περιεγχειρητικοί δείκτες ήταν ο POSSUM και το χειρουργικό Apgar score. Αποτελέσματα: Οι τιμές (min-max, μέση±ΣΑ) των διαφόρων δεικτών ήταν: CCI: 0-8, 1,5±1,8, AA-CCI: 0-11, 3,7±2,4, CIRS: 0-8, 3,0±2,1, ICED: 0-16, 4,7±3,9, ASA: 0-4, 2,2±0,7, MET: 2-6, 3,8±0,9, POSSUM: 20-44, 27,6±5,1 και χειρουργικό Apgar: 0-10, 6,2±1,4. Ολοι οι προεγχειρητικοί δείκτες έδειξαν στατιστικά σημαντική συσχέτιση με τον POSSUM (αντίστοιχα r2: 0,146, 0,148, 0,191, 0,260, 0,135 και 0,061), ενώ δεν σημειώθηκε στατιστικά σημαντική συσχέτιση κάποιου από αυτούς με το χειρουργικό Apgar score. Συμπεράσματα: Η μετεγχειρητική κατάσταση (χειρουργικό Apgar score) είναι ανεξάρτητη της προεγχειρητικής συνοδού νοσηρότητας, άρα απαιτείται καλύτερος προσδιορισμός των διεγχειρητικών παραγόντων που καθορίζουν τον μετεγχειρητικό κίνδυνο νοσηρότητας/θνησιμότητας. Αντίθετα, οι προεγχειρητικοί δείκτες συνοδού νοσηρότητας και χειρουργικού κινδύνου συσχετίζονται με περιεγχειρητικούς δείκτες πρόβλεψης κινδύνου νοσηρότητας/θνητότητας. Η αναφορά των δεικτών αυτών θα πρέπει να γίνεται ανάλογα με την προεγχειρητική νοσηρότητα προκειμένου να μπορεί να γίνει με δίκαιο τρόπο η σύγκριση της απόδοσης χειρουργών και νοσοκομείων σε συγκεκριμένες επεμβάσεις.

scholarly journals Comorbidity in patients with lymphoproliferative diseases

2020 ◽  
Vol 96 (7) ◽  
pp. 508-514
Author(s):  
E. V. Ignatyeva ◽  
E. V. Kryukov ◽  
V. A. Chernetsov ◽  
О. A. Rukavitsyn
Keyword(s):  
T Cell ◽  
Charlson Comorbidity Index ◽  
Rating Scale ◽  
Cell Leukemia ◽  
Lymphoproliferative Diseases ◽  
Prolymphocytic Leukemia ◽  
Number Of Patients ◽  
Comorbidity Index ◽  
Hodgkin's Lymphomas ◽  
Immunodeficiency States

Purpose of the study. To make an informed assessment of comorbidity in patients with lymphoproliferative diseases. To evaluate the effectiveness of comorbidity scales CCI and CIRS-G in patients with lymphoproliferative diseases under treatment. To evaluate the effect of the conducted immunochemotherapy on the general comorbidity in this category of patients.Material and methods. Two scales were used for calculations: Charlson Comorbidity Index (CCI) and Cumulative Illness Rating Scale for Geriatrics (CIRS-G). 127 primary patients with lymphoproliferative diseases aged 19 to 95 years old (the average age was 51.4) were examined from January 2018 till October 2019. The distribution of patients was based on the types of diseases: non-Hodgkin’s lymphomas — 59 (46.46%), Hodgkin’s lymphoma — 35 (27.56%), multiple myeloma — 20 (15.77%), chronic lymphocytic leukemia — 7 (5.51%) people, Waldenstrom’s macroglobulinemia — 3 (2.36%); each of the following diseases: hairy cell leukemia, T-cell leukemia of large granular lymphocytes, T-cell prolymphocytic leukemia - 1, amounted to 0.78% each.Results. Comorbidity was detected in 46 patients who received immunotherapy, chemotherapy, combined chemoradiotherapy, which amounted to 36.22% of the total number of patients. Lesions of the peripheral and central nervous system — 20 (43.48%) patients, were diagnosed most frequently. Immunodefi ciency states — 19 (41.30%) people, came next, and diseases of the cardiovascular system — 12 (26.08%) patients, appeared to be least frequent.Conclusions. When recalculating comorbidity on the CCI and CIRS-G scales, a significant aggravation of comorbidity after treatment, an increase in moderate and severe comorbidity were noted. According to the effectiveness of the CCI and CIRS-G scales in the treated patients, comorbidity is evaluated only approximately, since the Charlson Comorbidity Index does not include polyneuropathy, immunodeficiency states, thrombosis, ischemic heart disease, cardiac arrhythmias, gastritis, and thromboembolic complications and immunodeficiency states are absent in the CIRS-G scale. It is advisable to develop scales for assessing comorbidity, free from disadvantages mentioned above.

scholarly journals FRI0514 USE OF OPIATE FOR HIP AND KNEE OSTEOARTHRITIS BEFORE AND AFTER JOINT REPLACEMENT SURGERY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 856.1-856
Author(s):  
C. Lao ◽  
D. Lees ◽  
D. White ◽  
R. Lawrenson
Keyword(s):  
New Zealand ◽  
Knee Osteoarthritis ◽  
Knee Replacement ◽  
Charlson Comorbidity Index ◽  
Hip Osteoarthritis ◽  
Index Score ◽  
Charlson Comorbidity Index Score ◽  
Joint Replacement Surgery ◽  
Before And After ◽  
Comorbidity Index

Background:Osteoarthritis of the hip and knee is one of the most common causes of reduced mobility. It also causes stiffness and pain. Opioids can offer pain relief but is usually used for severe acute pain caused by major trauma or surgery. The use of opioids for relief of chronic pain caused by arthritis has increased over the last few decades.[1]Objectives:This study aims to investigate the use of strong opiates for patients with hip and knee osteoarthritis before and after joint replacement surgery, over a 13 years period in New Zealand.Methods:This study included patients with osteoarthritis who underwent publicly funded primary hip and knee replacement surgeries in 2005-2017 in New Zealand. These records were identified from the National Minimum Dataset (NMD). They were cross referenced with the NZJR data to exclude the admissions not for primary hip or knee replacement surgeries. Patients without a diagnosis of osteoarthritis were excluded.The PHARMS dataset was linked to the NMD to identify the use of strong opiates before and after surgeries. The strong opiates available for community dispensing in New Zealand and included in this study are: dihydrocodeine, fentanyl, methadone, morphine, oxycodone and pethidine. Use of opiate within three months prior to surgery and within 12 months post-surgery were examined by gender, age group, ethnicity, Charlson Comorbidity Index score and year of surgery. Differences by subgroup was examined with Chi- square test. Logistic regression model was used to calculate the adjusted odds ratios of strong opiate use before and after surgery compared with no opiate use.Results:We identified 53,439 primary hip replacements and 50,072 primary knee replacements with a diagnosis of osteoarthritis. Of patients with hip osteoarthritis, 6,251 (11.7%) had strong opiate before hip replacement surgeries and 11,939 (22.3%) had opiate after surgeries. Of patients with knee osteoarthritis, 2,922 (5.8%) had strong opiate before knee replacement surgeries and 15,252 (30.5%) had opiate after surgeries.The probability of patients with hip and knee osteoarthritis having opiate decreased with age, increased with Charlson comorbidity index score, and increased over time both before and after surgeries. Male patients with hip and knee osteoarthritis were less likely to have opiate than female patients both before and after surgeries. New Zealand Europeans with hip and knee osteoarthritis were more likely to receive opiate than other ethnic groups prior to surgeries, but were less likely to have opiate than Asians post-surgeries.Patients who had opiate before surgeries were more likely to have opiate after surgeries than those who did not have opiate before surgeries. The odds ratio was 8.34 (95% confidence interval (CI): 7.87-8.84) for hip osteoarthritis and 11.94 (95% CI: 10.84-13.16) for knee osteoarthritis after adjustment for age, gender, ethnicity, year of surgery and Charlson comorbidity index score. Having opiate prior to surgeries also increased the probability of having opiate for 6 weeks or more after surgeries substantially. The adjusted odds ratio was 21.46 (95% CI: 19.74-23.31) for hip osteoarthritis and 27.22 (95% CI: 24.95-29.68) for knee osteoarthritis.Conclusion:Preoperative opiate holidays should be encouraged. Multiple strategies need to be used to develop analgesic plans that allow adequate rehabilitation, without precipitating a chronic opiate dependence. Clinicians would also benefit from clear guidelines for prescribing strong opiates.References:[1] Nguyen, L.C., D.C. Sing, and K.J. Bozic,Preoperative Reduction of Opioid Use Before Total Joint Arthroplasty.J Arthroplasty, 2016.31(9 Suppl): p. 282-7.Disclosure of Interests:None declared

scholarly journals Variables determining clinical complexity in hospitalized Internal Medicine patients: a workload analysis

2017 ◽  
Vol 11 (2) ◽  
pp. 202
Author(s):  
Valentina Tommasi ◽  
Alessandra Campolongo ◽  
Irene Caridi ◽  
Simone Gatti ◽  
Lorena Lagana ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Rating Scale ◽  
Univariate Analysis ◽  
Index Patient ◽  
Clinical Severity ◽  
Optimal Care ◽  
Workload Analysis ◽  
High Type ◽  
Clinical Complexity ◽  
Comorbidity Index

The clinical complexity of Internal Medicine patients is a daily challenge for clinicians. Although clinical complexity cannot be directly measured, several scores describe the variability of clinical severity and comorbidity. The aim of this study was to analyze staff workload by assessing the nursing and medical complexity of patients admitted to an Internal Medicine ward. We included 40 consecutive inpatients [52.5% females, mean age 71.2 (18.2) years] classified according to the index of clinical complexity (ICC, type A: very high; type B: high; type C: moderate) and the cumulative illness rating scale (CIRS) severity and comorbidity index. Patient outcomes, hospitalization duration, tests performed, number of daily medications and time to perform standard nursing tasks were analysed across groups. Mean duration of hospitalization was 15.6 (10.1) days; in-hospital mortality was 15%. Mean CIRS severity index (SI) was 1.03 (0.31) and median CIRS comorbidity index (CI) was 2 (range 1-5). Significant differences were observed among ICC groups in time spent performing specific tasks [univariate analysis of variance F(2.37)=17.26, P&lt;0.001]. No significant differences were found between the three groups for mean CIRS-SI [F(2.37)=3.033, P=0.060] and median CIRS-CI [Kruskal Wallis test: c<sup>2</sup>(2)= 1.672, P=0.433]. Clinical complexity and caring complexity were not correlated in our sample of Internal Medicine inpatients. Optimal care of Internal Medicine patients must take into account their complexity in both the medical and nursing aspects.

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