Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain.
Servei de Cardiologia, Hospital Clínic Universitari de València, INCLIVA, Universitat de València, CIBERCV, València, Spain.
Eur J Intern Med. 2019 Apr;62:48-53. doi: 10.1016/j.ejim.2019.01.018. Epub 2019 Jan 31.
The Charlson's is the most used comorbidity index. It comprises 19 comorbidities, some of which are infrequent in elderly patients with acute coronary syndrome (ACS), while some others are manifestations of cardiac disease rather than comorbidities. Our goal was to simplify comorbidity assessment in elderly non-ST-segment elevation ACS patients.
The study group consisted of 1 training (n = 920, 76 ± 7 years) and 1 testing (n = 532; 84 ± 4 years) cohorts. The end-point was all-cause mortality at 1-year follow-up. Comorbidities were assessed selecting those medical disorders other than cardiac disease that were independently associated with mortality by multivariable analysis.
A total of 130 (14%) patients died in the training cohort. Six comorbidities were predictive: renal failure, anemia, diabetes, peripheral artery disease, cerebrovascular disease and chronic lung disease. The increase in the number of comorbidities yielded a gradient of risk on top of well-known clinical predictors: ≥3 comorbidities (27% mortality, HR = 1.90, 95% CI 1.20-3.03, p = .006); 2 comorbidities (16% mortality, HR = 1.29, 95% CI 0.81-2.04, p = .30); and 0-1 comorbidities (7.6% mortality, reference category). The discrimination accuracy (C-statistic = 0.80) and calibration (Hosmer-Lemeshow test, p = .20) of the predictive model using the 6 comorbidities was comparable to the predictive model using the Charlson index (C-statistic = 0.80; Hosmer-Lemeshow test, p = .70). Similar results were reproduced in the testing cohort (≥3 comorbidities: 24% mortality, HR = 2.37, 95% CI 1.25-4.49, p = .008; 2 comorbidities: 14% mortality, HR = 1.59, 95% CI 0.82-3.07, p = .20; 0-1 comorbidities: 7.5% reference category).
A simplified comorbidity assessment comprising 6 comorbidities provides useful risk stratification in elderly patients with ACS.
Charlson 合并症指数是最常用的合并症指数。它包括 19 种合并症，其中一些在急性冠状动脉综合征（ACS）的老年患者中并不常见，而另一些则是心脏病的表现而不是合并症。我们的目标是简化老年非 ST 段抬高型 ACS 患者的合并症评估。
研究组包括 1 个训练队列（n=920 例，76±7 岁）和 1 个测试队列（n=532 例；84±4 岁）。终点是 1 年随访时的全因死亡率。通过多变量分析选择与死亡率独立相关的除心脏病以外的其他医学疾病来评估合并症。
训练队列中有 130 例（14%）患者死亡。6 种合并症具有预测性：肾功能衰竭、贫血、糖尿病、外周动脉疾病、脑血管疾病和慢性肺部疾病。合并症数量的增加在已知的临床预测因素之上产生了风险梯度：≥3 种合并症（死亡率 27%，HR=1.90，95%CI 1.20-3.03，p=0.006）；2 种合并症（死亡率 16%，HR=1.29，95%CI 0.81-2.04，p=0.30）；0-1 种合并症（死亡率 7.6%，参考类别）。使用 6 种合并症的预测模型的判别准确性（C 统计量=0.80）和校准（Hosmer-Lemeshow 检验，p=0.20）与使用 Charlson 指数的预测模型相当（C 统计量=0.80；Hosmer-Lemeshow 检验，p=0.70）。在测试队列中也得到了类似的结果（≥3 种合并症：死亡率 24%，HR=2.37，95%CI 1.25-4.49，p=0.008；2 种合并症：死亡率 14%，HR=1.59，95%CI 0.82-3.07，p=0.20；0-1 种合并症：死亡率 7.5%，参考类别）。
包含 6 种合并症的简化合并症评估可为 ACS 老年患者提供有用的风险分层。
