Zahra Anum, van Smeden Maarten, Elders Petra J M, Festen Jan, Gussekloo Jacobijn, Joling Karlijn J, van Loon Anouk, Luijken Kim, Melis René J F, Mooijaart Simon P, Moons Karel G M, Peeters Geeske, Polinder-Bos Harmke A, Wouters Fenne, de Hond Anne
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands.
BMC Geriatr. 2025 Jan 30;25(1):67. doi: 10.1186/s12877-025-05721-2.
During the COVID-19 pandemic, nursing home (NH) residents faced the highest risk of severe COVID-19 disease and mortality. Due to their frailty status, comorbidity burden can serve as a useful predictive indicator of vulnerability in this frail population. However, the prognostic value of these cumulative comorbidity scores like the Charlson comorbidity index (CCI) remained unclear in this population. We evaluated the incremental predictive value of the CCI for predicting 28-day mortality in NH residents with COVID-19, compared to prediction using age and sex only.
We included older individuals of ≥ 70 years of age in a large retrospective observational cohort across NHs in the Netherlands. Individuals with PCR-confirmed COVID-19 diagnosis from 1 March 2020 to 31 December 2021 were included. The CCI score was computed by searching for the comorbidities recorded in the electronic patient records. All-cause mortality within 28 days was predicted using logistic regression based on age and sex only (base model) and by adding the CCI to the base model (CCI model). The predictive performance of the base model and the CCI model were compared visually by the distribution of predicted risks and area under the receiver operator characteristic curve (AUROC), scaled Brier score, and calibration slope.
A total of 4318 older NH residents were included in this study with a median age of 88 years [IQR: 83-93] and a median CCI score of 6 [IQR: 5-7]. 1357 (31%) residents died within 28 days after COVID-19 diagnosis. The base model, with age and sex as predictors, had an AUROC of 0.61 (CI: 0.60 to 0.63), a scaled brier score of 0.03 (CI: 0.02 to 0.04), and a calibration slope of 0.97 (CI: 0.83 to 1.13). The addition of CCI did not improve these predictive performance measures.
The addition of the CCI as a vulnerability indicator did not improve short-term mortality prediction in NH residents. Similar (high) age and number of comorbidities in the NH population could reduce the effectiveness of these predictors, emphasizing the need for other population-specific predictors that can be utilized in the frail NH residents.
在新冠疫情期间，养老院居民面临感染新冠病毒后病情严重及死亡的最高风险。由于他们身体虚弱，合并症负担可作为这一脆弱人群易感性的有效预测指标。然而，像查尔森合并症指数（CCI）这类累积合并症评分在该人群中的预后价值仍不明确。我们评估了CCI对预测新冠病毒感染养老院居民28天死亡率的增量预测价值，并与仅使用年龄和性别进行预测的情况作比较。
我们纳入了荷兰养老院中年龄≥70岁的老年人，组成一个大型回顾性观察队列。纳入2020年3月1日至2021年12月31日期间新冠病毒核酸检测确诊的个体。通过在电子病历中搜索记录的合并症来计算CCI评分。仅基于年龄和性别（基础模型）以及在基础模型中加入CCI（CCI模型），使用逻辑回归预测28天内的全因死亡率。通过预测风险分布、受试者工作特征曲线下面积（AUROC）、标准化Brier评分和校准斜率直观比较基础模型和CCI模型的预测性能。
本研究共纳入4318名老年养老院居民，中位年龄为88岁[四分位间距：83 - 93]，中位CCI评分为6[四分位间距：5 - 7]。1357名（31%）居民在新冠病毒诊断后28天内死亡。以年龄和性别作为预测因素的基础模型，AUROC为0.61（95%置信区间：0.60至0.63），标准化Brier评分为0.03（95%置信区间：0.02至0.04），校准斜率为0.97（95%置信区间：0.83至1.13）。加入CCI并未改善这些预测性能指标。
将CCI作为易感性指标并不能改善养老院居民的短期死亡率预测。养老院人群中相似的（高龄）年龄和合并症数量可能会降低这些预测因素的有效性，这凸显了需要其他可用于身体虚弱的养老院居民的特定人群预测指标。
