Coyan Garrett N, Chin Hannah, Shah Ayesha, Miguelino Alyssa M, Wang Yisi, Kilic Arman, Sultan Ibrahim, Sciortino Christopher M, Chu Danny
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
J Surg Res. 2022 Jul;275:300-307. doi: 10.1016/j.jss.2022.02.012. Epub 2022 Mar 18.
The Charlson Comorbidity Index (CCI) is widely utilized for risk stratification by providers, payors, and administrative database researchers for non-cardiac surgical patients. CCI scores have not been validated in cardiac surgical patients. We hypothesize that the CCI will predict mid-term mortality and re-admissions, but performance may be different than purpose-built cardiac surgery risk calculators.
Patients undergoing isolated CABG between 2011 and 2017 were reviewed. Age-adjusted CCI scores were calculated based on clinical status at a time of index operation using prospectively captured data from institutional databases. Primary endpoint was 5-year mortality and 1-year re-admissions. The CCI, STS predicted mortality, and ASCERT 5-year mortality scores were compared in a sub-cohort of 500 patients. Patients underwent analysis using Cox Proportional Hazard ratios, Kaplan-Meier analysis, and ROC comparisons.
Average CCI score for the overall population (n = 6064) was 3.40 ± 1.75. Kaplan-Meier analysis revealed significant difference in mortality stratified by CCI. Hazard ratio for 5-year mortality increased with each interval increase in CCI score value (HR 1.38 [1.33-1.43], P < 0.001), as did the risk of 1-year re-admission (HR 1.19 [1.15-1.22], P < 0.001). ROC curves for CCI, STS mortality, and ASCERT 5-year mortality risk demonstrate that all three scores are predictive at 5 y, but the ASCERT score performs best (ROC 0.76 versus 0.69, P = 0.004).
The CCI can serve as a useful mid-term risk stratification tool in patients undergoing CABG when variables for the purpose-built STS and ASCERT scores are unavailable. However, the ASCERT score performs better at 5-year mortality calculation.
查尔森合并症指数（CCI）被医疗服务提供者、支付方和行政数据库研究人员广泛用于非心脏手术患者的风险分层。CCI评分尚未在心脏手术患者中得到验证。我们假设CCI将预测中期死亡率和再入院情况，但其表现可能与专门构建的心脏手术风险计算器不同。
回顾了2011年至2017年间接受单纯冠状动脉旁路移植术（CABG）的患者。根据索引手术时的临床状况，使用机构数据库中前瞻性收集的数据计算年龄调整后的CCI评分。主要终点是5年死亡率和1年再入院率。在500例患者的亚组中比较了CCI、胸外科医师协会（STS）预测死亡率和ASCERT 5年死亡率评分。患者使用Cox比例风险比、Kaplan-Meier分析和ROC比较进行分析。
总体人群（n = 6064）的平均CCI评分为3.40±1.75。Kaplan-Meier分析显示，按CCI分层的死亡率存在显著差异。5年死亡率的风险比随着CCI评分值每增加一个区间而增加（风险比1.38 [1.33 - 1.43]，P < 0.001），1年再入院风险也是如此（风险比1.19 [1.15 - 1.22]，P < 0.001）。CCI、STS死亡率和ASCERT 5年死亡率风险的ROC曲线表明，所有三个评分在5年时都具有预测性，但ASCERT评分表现最佳（ROC为0.76对0.69，P = 0.004）。
当无法获得专门构建的STS和ASCERT评分的变量时，CCI可作为接受CABG患者有用的中期风险分层工具。然而，ASCERT评分在计算5年死亡率方面表现更好。
