The Best Use of the Charlson Comorbidity Index With Electronic Health Care Database to Predict Mortality
The Best Use of the Charlson Comorbidity Index With Electronic Health Care Database to Predict Mortality
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DOI：
10.1097/mlr.0000000000000471
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发表时间：
2016-02-01
期刊：
影响因子：
3
通讯作者：
Alla, Francois
中科院分区：
文献类型：
--
作者：
Bannay, Aurelie;Chaignot, Christophe;Alla, Francois
背景：测量合并症最常用的评分是Charlson指数。它的应用程序，包括国际疾病分类，第10版（ICD-10）的代码，医疗程序和药物治疗的卫生保健管理数据库需要研究其生存的属性。我们的目标是适应的Charlson合并症指数的法国国民健康保险数据库，预测1年的死亡率出院患者和比较歧视和校准的不同版本的Charlson index.Methods：我们的队列包括所有成年人出院的住院时间在法国在2010年登记在法国国民健康保险的一般计划。Charlson指数的病理通过ICD-10代码的出院诊断和长期疾病，具体的医疗程序，并在过去12个月的具体药物报销including.Results：我们纳入了6,602,641名受试者在其第一次出院的日期从内科，外科，产科在2010年。一年生存率为94.88%，从Charlson指数0的98.41%下降到Charlson指数>= 5的71.64%。与0.91的歧视和适当的校准曲线，我们保留了原油考克斯模型，包括年龄调整后的Charlson指数作为4-levelscores.Conclusions：我们的研究是第一个适应Charlson指数的大型医疗保健数据库，包括> 6万住院患者。当死亡率是结局时，我们建议使用年龄调整的Charlson指数作为4级评分，以考虑合并症。
Background:The most used score to measure comorbidity is the Charlson index. Its application to a health care administrative database including International Classification of Diseases, 10th edition (ICD-10) codes, medical procedures, and medication required studying its properties on survival. Our objectives were to adapt the Charlson comorbidity index to the French National Health Insurance database to predict 1-year mortality of discharged patients and to compare discrimination and calibration of different versions of the Charlson index.Methods:Our cohort included all adults discharged from a hospital stay in France in 2010 registered in the French National Health Insurance general scheme. The pathologies of the Charlson index were identified through ICD-10 codes of discharge diagnoses and long-term disease, specific medical procedures, and reimbursement of specific medications in the past 12 months before inclusion.Results:We included 6,602,641 subjects at the date of their first discharge from medical, surgical, or obstetrical department in 2010. One-year survival was 94.88%, decreasing from 98.41% for Charlson index of 0-71.64% for Charlson index of >= 5. With a discrimination of 0.91 and an appropriate calibration curve, we retained the crude Cox model including the age-adjusted Charlson index as a 4-level score.Conclusions:Our study is the first to adapt the Charlson index to a large health care database including > 6 million of inpatients. When mortality is the outcome, we recommended using the age-adjusted Charlson index as 4-level score to take into account comorbidities.