Charlson Index comorbidity adjustment for ischemic stroke outcome studies
Charlson Index comorbidity adjustment for ischemic stroke outcome studies
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DOI：
10.1161/01.str.0000135225.80898.1c
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发表时间：
2004-08-01
期刊：
影响因子：
8.3
通讯作者：
Horner, RD
中科院分区：
文献类型：
--
作者：
Goldstein, LB;Samsa, GP;Horner, RD
背景和目的-Charlson指数通常用于结果研究，以调整患者的合并症情况，但尚未被特别验证用于缺血性中风的研究。本研究的目的是确定缺血性中风患者的预后是否因Charlson指数的不同而不同。方法：退伍军人事务部(VA)卒中研究前瞻性地确定了1995年4月至1997年3月间在9家VA医院住院的中风患者。Charlson指数根据出院国际疾病分类第9版、临床修改编码和二分法(低共病0或1与高共病大于或等于2)进行评分。根据出院时修正的Rankin评分(好的结果为0或1，差的结果大于或等于2或死亡)和1年死亡率来评估有效性，并调整初始卒中的严重程度。结果：在960名入选的缺血性中风患者中，23%的Charlson指数为0，34%的患者为1，22%的患者为2，12%的患者为3，8%的患者的Charlson指数大于或等于4。查尔森指数低的患者中有48%的患者出院效果良好，而查尔森指数高的患者中这一比例为37%(P<；0.001)。1年死亡率分别为16%和26%(P<；0.001)。Logistic回归校正初始卒中严重程度显示，查尔森指数高的患者出院时预后不良的几率增加36%(P=0.038)，1年后死亡的几率增加72%(P=0.001)。Charlson指数每增加1点，出院时不良结局的几率增加15%(P<；0.005)，1年内死亡的几率增加29%(P<；0.001)。结论--这些数据支持Charlson指数作为用于缺血性卒中结果研究的共病指标的有效性。
Background and Purpose-The Charlson Index is commonly used in outcome studies to adjust for patient comorbid conditions, but has not been specifically validated for use in studies of ischemic stroke. The purpose of the present study was to determine whether outcomes of ischemic stroke patients varied on the basis of the Charlson Index.Methods-The Department of Veterans Affairs (VA) Stroke Study prospectively identified stroke patients admitted to 9 VA hospitals between April 1995 and March 1997. The Charlson Index was scored on the basis of discharge International Classification of Diseases, 9th Revision, Clinical Modification coding and dichotomized (low comorbidity 0 or 1 versus high greater than or equal to2) for analysis. Validity was assessed on the basis of modified Rankin score at hospital discharge ( good outcome 0 or 1 versus poor greater than or equal to2 or dead) and 1-year mortality, adjusting for initial stroke severity.Results-Of the 960 enrolled ischemic stroke patients, 23% had a Charlson Index of 0, 34% 1, 22% 2, 12% 3, and 8% greater than or equal to4. Forty-eight percent of those with a low Charlson Index had a good outcome at discharge versus 37% of those with a high Charlson Index (P < 0.001). For 1-year mortality, the proportions were 16% versus 26%, respectively (P < 0.001). Logistic regression adjusting for initial stroke severity showed that those with a high Charlson Index had 36% increased odds of having a poor outcome at discharge (P = 0.038) and 72% greater odds of death at 1 year (P = 0.001). Every 1-point increase in Charlson Index was independently associated with a 15% increase in the odds of a poor outcome at discharge (P < 0.005) and a 29% increase in the odds of death by 1 year (P < 0.001).Conclusions-These data support the validity of the Charlson Index as a measure of comorbidity for use in ischemic stroke outcome studies.