Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery
Using the age-adjusted Charlson comorbidity index to predict outcomes in emergency general surgery
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DOI：
10.1097/ta.0000000000000457
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发表时间：
2015-02-01
影响因子：
3.4
通讯作者：
Khwaja, Kosar
中科院分区：
文献类型：
--
作者：
St-Louis, Etienne;Iqbal, Sameena;Khwaja, Kosar
背景：我们评估了Charlson年龄合并症指数（CACI）在预测加拿大一家大型教学医院急诊普通外科人群围手术期结局中的作用，CACI是一种反映1年死亡率累积增加可能性的加权合并症指数。方法：对2010年急诊普外科住院病例进行回顾性分析。进行手术的患者被确认。记录手术方式和CACI，以及结果指标，包括30天死亡率和重症监护病房（ICU）入住情况。建立多变量逐步logistic回归模型，评估年龄校正Charlson合并症指数对术后预后的影响，同时控制可能的混杂因素的影响。考虑曲线下面积及其95%置信区间（ci），采用受试者工作特征分析评估CACI对死亡率的预测能力。结果：在529例急诊科普通外科住院患者中，257例患者接受了手术干预。CACI得分范围从0到16。我们共记录了11例死亡（4.3%）和30例ICU入院（11.7%）。CACI与30天死亡率增加相关（校正优势比为1.39；95% CI为1.11-1.73;p = 0.0034）。受试者工作特征分析与CACI单独预测死亡率的准确性一致，曲线下面积或c统计量为0.90 （95% CI, 0.84-0.95）。CACI在预测死亡率方面与多变量模型相似。CACI也与ICU住院相关（校正优势比1.17;95% CI 1.01-1.37; p < 0.0382）。与多变量模型相比，CACI不能很好地预测ICU住院。结论：我们已经表明，CACI是一个有效的工具，30天死亡率预测在急诊普外科的背景下。（版权所有）2015威科集团健康有限公司版权所有。)证据等级：预后研究，III级。
BACKGROUND: 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.METHODS: 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).RESULTS: 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.CONCLUSION: We have shown that the CACI is a valid tool for 30-day mortality prediction in the context of emergency general surgery. (Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.)LEVEL OF EVIDENCE: Prognostic study, level III.