Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients

Purpose

The Charlson comorbidity index (CCI) is a commonly used scale for assessing morbidity, but its role in assessing mortality in hemodialysis patients is not clear. Age, a component of CCI, is a strong risk factor for morbidity and mortality in chronic diseases and correlates with comorbidities. We hypothesized that the Charlson comorbidity index without age is a strong predictor of mortality in hemodialysis patients.

Methods

A 6-year cohort of 893 hemodialysis patients was examined for an association between a modified CCI (without age and kidney disease) (mCCI) and mortality.

Results

Patients were 53?±?15?years old (mean?±?SD), had a median mCCI score of 2, and included 47% women, 31% African Americans and 55% diabetics. After adjusting for case-mix and nutritional and inflammatory markers including C-reactive protein and interleukin-6, 2nd (mCCI: 1?C2), 3rd (mCCI?=?3), and 4th (mCCI: 4?C9) quartiles compared to 1st (mCCI?=?0) quartiles showed death hazard ratios (95% confidence intervals) of 1.43 (0.92?C2.23), 1.70 (1.06?C2.72), and 2.33 (1.43?C3.78), respectively. The mCCI-death association was robust in non-African Americans. The CCI-death association linearity was verified in cubic splines. Each 1 unit higher mCCI score was associated with a death hazard ratio of 1.16 (1.07?C1.27).

Conclusions

CCI independent of age is a robust and linear predictor of mortality in hemodialysis patients, in particular in non-African Americans.     

Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer

According to the European Association of Urology （EAU） guidelines, a life expectancy of〉 10 years is considered an important factor in the treatment of prostate cancer. The Charlson score is used to predict mortality based on comorbidities. The purpose of this study was to investigate the relationship between age, Charlson score and outcome in patients with cT3a prostate cancer. Between 1987 and 2004, 200 patients, who were with clinical T3a prostate cancer and who underwent radical prostatectomy （RP）, were previously detected by digital rectal examination （DRE）. Patients were categorized into two age groups （〈 65 and≥65 years old）. Patients were also divided into two groups according to Charlson score （ = 0 and ≥ 1）. Both age and Charlson score were analyzed regarding their predictive power of patients＇ outcomes. The mean follow-up period was 70.6 months, and the mean age of patients was 63.3 years. In all, 106 patients were 〈 65 years old and 94 patients were ≥65 years old. Age was a significant predictor of overall survival （OS）. A Charlson score of 0 was found in 110 patients, and of ≥ 1 in 90 patients. Charlson score was not a significant predictor of biochemical progression-free survival （BPFS）, clinical progression-free survival （CPFS） or OS. Cox multivariate analysis showed that margin status was a significant independent factor in BPFS, and cancer volume was a significant independent factor in CPFS. Charlson score does not influence the outcome in patients with clinical locally advanced prostate cancer. Age may influence OS. RP can be performed in motivated healthy older patients. However, the patients need to be counseled regarding possible surgery-related side effects, such as urinary incontinence and erectile dysfunction, which are age- and comorbidity-dependent.     

Older patients with low Charlson score and high-risk prostate cancer benefit from radical prostatectomy

Introduction

The aim of the study was to identify the appropriate level of Charlson comorbidity index (CCI) in older patients (>70 years) with high-risk prostate cancer (PCa) to achieve survival benefit following radical prostatectomy (RP).

Methods

We retrospectively analyzed 1008 older patients (>70 years) who underwent RP with pelvic lymph node dissection for high-risk prostate cancer (preoperative prostate-specific antigen >20 ng/mL or clinical stage ≥T2c or Gleason ≥8) from 14 tertiary institutions between 1988 and 2014. The study population was further grouped into CCI < 2 and ≥2 for analysis. Survival rate for each group was estimated with Kaplan–Meier method and competitive risk Fine-Gray regression to estimate the best explanatory multivariable model. Area under the curve (AUC) and Akaike information criterion were used to identify ideal ‘Cut off’ for CCI.

Results

The clinical and cancer characteristics were similar between the two groups. Comparison of the survival analysis using the Kaplan–Meier curve between two groups for non-cancer death and survival estimations for 5 and 10 years shows significant worst outcomes for patients with CCI ≥ 2. In multivariate model to decide the appropriate CCI cut-off point, we found CCI 2 has better AUC and p value in log rank test.

Conclusion

Older patients with fewer comorbidities harboring high-risk PCa appears to benefit from RP. Sicker patients are more likely to die due to non-prostate cancer-related causes and are less likely to benefit from RP.

     

Association of the Charlson comorbidity index and hypertension with survival in men with metastatic castration-resistant prostate cancer

ObjectivesThe independent prognostic effect of comorbidities on outcomes in men with metastatic castration-resistant prostate cancer (mCRPC) is unclear. We sought to determine whether the Charlson comorbidity index (CCI) and hypertension (HTN) are associated with overall survival (OS) independent of known clinical prognostic factors in mCRPC.Patients and methodsA retrospective analysis was conducted on 221 patients with mCRPC treated with docetaxel plus prednisone combined with AT-101 (bcl-2 antagonist) or placebo on a prospective randomized phase II trial. The Cox regression analysis was performed to identify whether the CCI or HTN or both (by medical history) independently predicted OS after adjusting for baseline variables known to be associated with OS. The Wilcoxon rank sum test and the Fisher exact test were used to compare data by comorbidity groups (CCI as a continuous variable, CCI = 6 vs. CCI ≥ 7 and HTN vs. no HTN).ResultsThe CCI was 6 in 116 patients (52.7%), 7 in 70 (31.8%), 8 in 23 (10.5%), 9 in 4 (1.8%), and 10 in 7 patients (3.2%). HTN was present in 107 (48.6%) patients. Patients with CCI of ≥7 were older and exhibited worse performance status and anemia than patients with CCI of 6 (P<0.05). The CCI was not independently predictive of OS on univariable and multivariable analyses. HTN alone or in combination with the CCI was borderline significantly associated with OS (P ~0.09) on both univariable and multivariable analyses.ConclusionsThe CCI did not predict OS independent of known prognostic factors in mCRPC. Age, performance status, and anemia may adequately capture comorbidities in the context of mCRPC, given their association with higher CCI. Further prospective study of comorbidities in a larger data set may be warranted. The study of HTN in a larger data set may also be warranted given its borderline-independent association with OS.     

Charlson comorbidity index as a predictor of long-term outcome after surgery for nonsmall cell lung cancer.

OBJECTIVE: To evaluate the impact of the Charlson comorbidity index on long-term survival in nonsmall cell lung cancer surgery and determine whether this index is a better predictor of long-term survival than individual comorbid conditions. METHODS: From January 1989 to December 2001, 433 (340 men, 93 women) consecutive curative resections for nonsmall cell lung cancer were performed. Each patient was preoperatively assessed according to the Charlson comorbidity index. Survival curves were estimated by the Kaplan-Meier method. Risk factors for overall and disease free survival were determined by univariate and multivariate Cox regression analysis. RESULTS: The patients ranged in age from 37 to 82 years, with a mean age of 65 years. Hospital mortality was 3.7%. Five-year overall and disease free survival was 45 and 43%, respectively. Among patients with Charlson comorbidity grade 0, 5-year overall survival was 52%, among patients with Charlson comorbidity grade 1-2 it was 48%, and among patients with Charlson comorbidity grade > or =3 it was 28%. Univariate analysis showed that male gender, age, congestive heart failure, chronic pulmonary disease, Charlson comorbidity index, clinical stage, pathological stage, and type of resection were significantly associated with an impaired survival. Multivariate analysis showed that age (relative risk, 1.02; 95% confidence interval, 1.01-1.03), Charlson comorbidity grade 1-2 (relative risk, 1.4; 95% confidence interval, 1.0-1.8), Charlson comorbidity grade > or =3 (relative risk, 2.2; 95% confidence interval, 1.5-3.1), bilobectomy (relative risk, 1.7; 95% confidence interval, 1.2-2.5), pneumonectomy (relative risk, 1.5; 95% confidence interval, 1.1-2.0), pathological stage IB (relative risk, 1.5; 95% confidence interval, 1.1-2.2), IIB (relative risk, 1.9; 95% confidence interval, 1.2-3.0), IIIA (relative risk, 1.9; 95% confidence interval, 1.1-3.1), IIIB (relative risk, 2.8; 95% confidence interval, 1.2-6.8), and IV (relative risk, 12.4; 95% confidence interval, 3.2-48.2), were associated with an impaired survival. CONCLUSIONS: The Charlson comorbidity index is a better predictor of survival than individual comorbid conditions in nonsmall cell lung cancer surgery. We recommend the use of a validated comorbidity index in the selection of patients for NSCLC surgery.     

The Charlson comorbidity index as a predictor of outcomes in liver transplantation: single-center experience

Several comorbidity indices, such as the Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) score, have been used to optimize available organ resources and adjust priorities in diagnosis and allocation of grafts for patients who are candidates for liver transplantation. There have also been various attempts to create instruments to accurately predict outcomes after liver transplantation, but none has proved to be truly applicable, with the exception of the Charlson comorbidity index (CCI). We retrospectively reviewed data of 221 liver recipients, including living-related liver transplantation and multiple organ transplantation performed between January 2006 and September 2009. Survival analysis revealed a significant association of the CCI with decreased posttransplantation patient survival (P = .003). Furthermore, Kaplan-Meier plots and log-rank test showed a significant association between graft survival and the score (P = .039). Our data suggest that the CCI is a simple tool for the evaluation of comorbidity and that increased preoperative patient comorbidity increases the risk of graft loss and patient death after liver transplantation. The CCI should be considered an important tool for improving patient care because of its potential applications for patient management.     

Simplified comorbidity score for elderly patients undergoing thoracoscopic surgery for lung cancer

Purpose

We investigated the efficiency of the Simplified Comorbidity Score (SCS) for predicting postoperative complications and prognosis in elderly patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer.

Methods

We reviewed 216 patients aged 75 years or older, who underwent pulmonary resection by VATS for lung cancer between January, 2005 and December, 2012. The SCS assigns different scores to patients’ comorbidities; namely, smoking (n = 7); diabetes mellitus (n = 5); renal insufficiency (n = 4); and respiratory, neoplastic, and cardiovascular comorbidities or alcoholism (n = 1 each). Patients were divided into a high SCS group (SCS ≥ 9; n = 154) and a low SCS group (<9; n = 62), for a comparative analysis of differences in perioperative factors and prognoses.

Results

Limited resection was more frequent in the high SCS group (58 %) than in the low SCS group (40 %; P = 0.02). Postoperative complications were more frequent in the high SCS group (45 %) than in the low SCS group (15 %; P < 0.01). A logistic regression analysis revealed that a high SCS was significantly predictive of postoperative complications (odds ratio 2.7; P = 0.02). The 5-year overall survival rate was 79 % for the low SCS group and 52 % for the high SCS group (P < 0.01).

Conclusions

The SCS can predict the likelihood of postoperative complications and prognosis of elderly patients with VATS-treated lung cancers.

     

一例寡转移前列腺癌患者基于循证医学的多学科综合诊治报告

目的探讨基于循证医学寡转移前列腺癌的综合治疗模式,以期延长患者生存时间。 方法回顾性分析一例在我院行多学科协作诊治的寡转移前列腺癌患者临床资料,复习相关文献并予以讨论。 结果患者初诊PSA为60 μg/L,盆腔MRI考虑前列腺癌,双侧精囊受侵,左侧输尿管口受侵,全身骨扫描可见四处骨转移,前列腺穿刺活检诊断为前列腺腺泡癌,Gleason评分4+5=9分。患者自2016年5月起以雄激素剥夺治疗为基础,先后序贯行新辅助化疗、减瘤性根治性前列腺切除术、立体定向放疗、阿比特龙+泼尼松治疗及再次多西他赛化疗,随访至2018年12月,患者无明显疼痛不适,但PSA升高,出现新发骨转移灶。 结论循证医学给此类患者治疗选择带来更多的依据,多学科治疗模式可延长寡转移前列腺癌患者生存时间,改善生活质量。     

癌症儿童多症状测评工具的范围综述

目的 比较国内外用于癌症患儿的多症状测评工具,为癌症患儿症状管理提供参考。方法 计算机检索PubMed、Web of Science、EMbase、中国期刊全文数据库、中国生物医学文献数据库、万方数据库,查找用于测评癌症患儿多症状评估的工具,检索时限为从建库至2022年9月。提取各工具的条目数、信效度、评分方法、适用对象等信息,对纳入工具进行描述。结果 最终纳入9个持续性评估工具,共28篇全文文献,其中9篇关于评估工具的开发、19篇关于评估工具的运用。结论 目前癌症患儿的多症状测评工具良莠不齐,有必要开发针对不同群体的多症状群测评工具,以保证动态追踪患儿的症状变化,拟订干预措施,促进癌症患儿的症状管理。     

Validation of the Charlson comorbidity index in patients with operated primary non-small cell lung cancer.

OBJECTIVE: To validate the influence of the Charlson comorbidity index (CCI) in patients with operated primary non-small cell lung cancer. METHODS: From January 1996 to December 2001, 205 consecutive resections for non-small cell lung cancer were performed at the Erasmus Medical Center Rotterdam. The patients ranged in age from 29 to 82 years, with a mean age of 64 years. In a retrospective study, each patient was scaled according to the CCI and the complications of surgery were determined. RESULTS: The hospital mortality was 2.4% (5/205). Of the 205 patients 167 (32.7%) experienced minor complications and 32 (15.6%) major complications. In univariate analysis, gender, grades 3-4 of the CCI, any prior tumor treated in the last 5 years and chronic pulmonary disease were significant predictors of adverse outcome. Multivariate analysis showed that only grades 3-4 of the CCI was predictive (odds ratio=9.8; 95% confidence interval=2.1-45.9). Although only comorbidity grades 3-4 was a significant predictor, for every increase of the comorbidity grade the relative risk of adverse outcome showed a slight increase. CONCLUSION: The CCI is strongly correlated with higher risk of surgery in primary non-small cell lung cancer patients and is a better predictor than individual risk factors.