Department of Cardiology, Angiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany.
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
Aging Clin Exp Res. 2019 Sep;31(9):1233-1242. doi: 10.1007/s40520-018-1067-x. Epub 2018 Nov 8.
The Charlson Comorbidity Index (CCI) is the most widely used assessment tool to report the presence of comorbid conditions. The Barthel index (BI) is used to measure performance in activities of daily living. We prospectively investigated the performance of CCI or BI to predict length of hospital stay (LOS), mortality, cardiovascular (CV) mortality and rehospitalization in unselected older patients on admission to the emergency department (ED). We also studied the association of CCI or BI with costs.
We consecutively enrolled 307 non-surgical patients ≥ 68 years presenting to the ED with a wide range of comorbid conditions. Baseline characteristic, clinical presentation, laboratory data, echocardiographic parameters and hospital costs were compared among patients. All patients were followed up for mortality, CV mortality and rehospitalization within the following 12 months. A multivariate analysis was performed.
Mortality was increased for patients having a higher CCI or BI with a hazard ratio around 1.17-1.26 or 0.75-0.81 (obtained for different models) for one or ten point increase in CCI or BI, respectively. The prognostic impact of a high CCI or BI on CV mortality and rehospitalization was also significant. In a multiple linear regression using the same independent variables, CCI and BI were identified as a predictor of LOS in days. Multiple linear regression analysis did not confirm an association between CCI and costs, but for BI after adjusting for multiple factors.
CCI and BI independently predict LOS, mortality, CV mortality, and rehospitalization in unselected older patients admitted to ED.
Charlson 合并症指数（CCI）是最广泛用于报告合并症存在的评估工具。Barthel 指数（BI）用于衡量日常生活活动能力。我们前瞻性地研究了 CCI 或 BI 预测非选择性老年患者急诊就诊时住院时间（LOS）、死亡率、心血管（CV）死亡率和再入院的表现。我们还研究了 CCI 或 BI 与成本的关系。
我们连续纳入了 307 名年龄≥68 岁的非手术患者，这些患者因各种合并症就诊于急诊科。比较了患者的基线特征、临床表现、实验室数据、超声心动图参数和住院费用。所有患者在接下来的 12 个月内进行了死亡率、CV 死亡率和再入院的随访。进行了多变量分析。
CCI 或 BI 较高的患者死亡率增加，风险比约为 1.17-1.26 或 0.75-0.81（在不同模型中获得），CCI 或 BI 每增加一个或十个点。高 CCI 或 BI 对 CV 死亡率和再入院的预后影响也很显著。在使用相同独立变量的多元线性回归中，CCI 和 BI 被确定为 LOS 天数的预测因子。多元线性回归分析并未证实 CCI 与成本之间存在关联，但在调整了多个因素后，BI 存在关联。
CCI 和 BI 独立预测非选择性老年患者急诊就诊时的 LOS、死亡率、CV 死亡率和再入院。
