The modified Charlson Comorbidity Index (MCCI) has been proposed as a tool for adjusting
the outcomes of stroke for comorbidity, but its validity in such a context has been
evaluated in only a few studies and needs to be further explored, especially in elderly
patients. We aimed to retrospectively assess the validity of the MCCI as a predictor
of the short-term outcomes in a cohort of 297 patients with first-ever ischemic stroke,
older than 60 years, and managed according to a clinical pathway. The poor outcome
(PO) at 1 month, defined as a modified Rankin Scale score of 3-6, was the primary
end point. Furthermore, a new comorbidity index has been developed, specific to our
cohort, according to the same statistical approach used for the original CCI. The
MCCI showed a positive association with PO (odds ratio [OR] 1.62; 95% confidence interval
[CI] .98-2.68) and mortality (hazard ratio [HR] 1.85; 95% CI .94-3.61), not statistically
significant and totally dependent on its association with the severity of neurologic
impairment at onset. The new comorbidity index showed, as expected, a significant
association with the PO and mortality with higher point estimates of OR (2.74; 95%
CI 1.64-4.59) and HR (2.73; 95% CI 1.51-4.94), but this association was also dependent
on stroke severity and premorbid disability. Our results do not support the validity
of the MCCI as a predictor of the short-term outcomes in elderly stroke patients nor
could we develop a more valid index from the available data. This suggests the need
for development of disease- and age-specific indexes, possibly according to a prospective
design. In any case, initial stroke severity, a strong predictor of outcome, is associated
with the degree of comorbidity.
Key Words
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References
- Comorbidity measures for stroke outcome research: a preliminary study.Arch Phys Med Rehabil. 1997; 78: 166-167
- Charlson Index comorbidity adjustment for ischemic stroke outcome studies.Stroke. 2004; 35: 1941-1945
- Impact of comorbidity on ischemic stroke outcome.Acta Neurol Scand. 2006; 113: 108-113
- Impact of comorbidities on ischemic stroke outcomes in women.Stroke. 2008; 39: 2138-2140
- Validation of the Charlson Comorbidity Index for predicting functional outcome of stroke.Arch Phys Med Rehabil. 2008; 89: 1276-1283
- Charlson Comorbidity Index adjustment in intracerebral hemorrhage.Stroke. 2011; 42: 2944-2946
- How to measure comorbidity: a critical review of available methods.J Clin Epidemiol. 2003; 56: 221-229
- A new method of classifying prognostic comorbidity longitudinal studies: development and validation.J Chronic Dis. 1987; 5: 371-383
- Critical pathways: a review.Circulation. 2000; 101: 461-465
- Measuring and improving quality of care. A report from the American Heart Association/American College of Cardiology first scientific forum on assessment of healthcare quality in cardiovascular disease and stroke.Stroke. 2000; 31: 1002-1012
- Guidelines for the early management of adults with ischemic stroke.Stroke. 2007; 38: 1655-1711
Stroke Prevention and Educational Awareness Diffusion (SPREAD). VII Edizione. Ictus cerebrale: linee guida italiane di prevenzione e trattamento. Available at: www.siapav.it. (accessed Sept. 18 2014).
- The poor outcome of ischemic stroke in very old people: a cohort study of its determinants.J Am Geriatr Soc. 2010; 58: 12-17
- Interobserver agreement for the assessment of handicap in stroke patients.Stroke. 1988; 19: 604-607
- Assessment of outcome after severe brain damage: a practical scale.Lancet. 1975; 1: 480-484
- Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischaemic stroke—background and study protocol.Stroke. 1985; 16: 885-890
- Classification and natural history of clinically identifiable subtypes of cerebral infarction.Lancet. 1991; 337: 1521-1526
- Classification of subtypes of acute ischemic stroke: definition for use in a multicenter clinical trial: TOAST. Trial of Org 10 172 in Acute Stroke Treatment.Stroke. 1993; 24: 35-41
- Patterns of multimorbidity in the aged population. Results from the KORA-Age Study.Plos One. 2012; 7: e30556
- Patterns of chronic multimorbidity in the elderly population.J Am Geriatr Soc. 2009; 57: 225-230
- Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions.Plos One. 2010; 5: e15941
- Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases.J Clin Epidemiol. 1998; 51: 367-375
- Substantial effective sample sizes were required for external validation studies of predictive logistic regression models.J Clin Epidemiol. 2005; 58: 475-483
Article info
Publication history
Published online: December 09, 2014
Accepted:
August 27,
2014
Received in revised form:
August 22,
2014
Received:
January 9,
2014
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.08.034
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
