Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data From 6 Countries
Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data From 6 Countries
复制标题
DOI：
10.1093/aje/kwq433
复制
发表时间：
2011-03-15
影响因子：
5
通讯作者：
Sundararajan, Vijaya
中科院分区：
文献类型：
--
作者：
Quan, Hude;Li, Bing;Sundararajan, Vijaya
随着治疗和疾病管理有效性的进步，Charlson合并症指数中发现的慢性合并症（合并症）对死亡率的贡献可能自1984年该指数开发以来发生了变化。作者重新评估了Charlson指数，并通过识别和随访患者观察出院后1年内的死亡率来重新分配每种疾病的权重。他们将更新后的指数和权重应用于来自6个国家的出院数据，并测试其预测住院死亡率的能力。与原始Charlson权重相比，从加拿大阿尔伯塔卡尔加里数据（2004年）生成的权重对于5种合并症为0，对于3种合并症降低，对于4种合并症增加，对于5种合并症没有变化。在澳大利亚数据（2008年）、加拿大数据（2008年）、法国数据（2004年）、法国数据（2008年）、加拿大数据（2008年）、加拿大数据（2008年）、法国数据（2004年）中，用于区分12种合并症产生的新评分和Charlson评分之间的住院死亡率的C统计量分别为0.825（新）和0.808（旧），日本数据（2008年）为0.727和0.723，新西兰数据（2008年）为0.831和0.836，瑞士数据（2008年）为0.869和0.876。12种合并症的更新指数显示，在6个国家的数据中，在预测住院死亡率方面具有良好至极佳的区分度，可能更适合与最近的管理数据一起使用。
With advances in the effectiveness of treatment and disease management, the contribution of chronic comorbid diseases (comorbidities) found within the Charlson comorbidity index to mortality is likely to have changed since development of the index in 1984. The authors reevaluated the Charlson index and reassigned weights to each condition by identifying and following patients to observe mortality within 1 year after hospital discharge. They applied the updated index and weights to hospital discharge data from 6 countries and tested for their ability to predict in-hospital mortality. Compared with the original Charlson weights, weights generated from the Calgary, Alberta, Canada, data (2004) were 0 for 5 comorbidities, decreased for 3 comorbidities, increased for 4 comorbidities, and did not change for 5 comorbidities. The C statistics for discriminating in-hospital mortality between the new score generated from the 12 comorbidities and the Charlson score were 0.825 (new) and 0.808 (old), respectively, in Australian data (2008), 0.828 and 0.825 in Canadian data (2008), 0.878 and 0.882 in French data (2004), 0.727 and 0.723 in Japanese data (2008), 0.831 and 0.836 in New Zealand data (2008), and 0.869 and 0.876 in Swiss data (2008). The updated index of 12 comorbidities showed good-to-excellent discrimination in predicting in-hospital mortality in data from 6 countries and may be more appropriate for use with more recent administrative data.