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Validity of the modified Charlson Comorbidity Index as predictor of short-term outcome in older stroke patients
Licia Denti1, Andrea Artoni1, Monica Casella1
1Stroke Care Section, Geriatric Clinic, University Hospital of Parma, Italy.
Insights
The modified Charlson Comorbidity Index (MCCI) is not a valid predictor of short-term outcomes in elderly stroke patients. New comorbidity indices also showed limitations, highlighting the need for disease- and age-specific tools.
Area of Science:
- Neurology
- Geriatrics
- Epidemiology
Background:
- The modified Charlson Comorbidity Index (MCCI) is proposed for adjusting stroke outcomes by comorbidity.
- Its validity, particularly in elderly patients, requires further investigation.
Purpose of the Study:
- To assess the validity of the MCCI in predicting short-term outcomes in elderly patients with first-ever ischemic stroke.
- To develop and evaluate a new, cohort-specific comorbidity index.
Main Methods:
- Retrospective analysis of 297 elderly patients (age > 60) with first-ever ischemic stroke.
- Primary endpoint: poor outcome (modified Rankin Scale 3-6) at 1 month.
- Evaluation of MCCI and a newly developed comorbidity index.
Main Results:
- MCCI showed non-significant associations with poor outcome (OR 1.62) and mortality (HR 1.85), dependent on stroke severity.
- The new index had significant associations (OR 2.74, HR 2.73) but was also influenced by stroke severity and premorbid disability.
- Neither index proved to be a valid independent predictor.
Conclusions:
- The MCCI is not supported as a valid predictor of short-term outcomes in elderly stroke patients.
- The developed index also did not demonstrate sufficient validity.
- Disease- and age-specific indices, potentially using a prospective design, are needed for accurate outcome prediction in stroke.
Abstract:
The modified Charlson Comorbidity Index (MCCI) has been proposed as a tool for adjusting the outcomes of stroke for comorbidity, but its validity in such a context has been evaluated in only a few studies and needs to be further explored, especially in elderly patients. We aimed to retrospectively assess the validity of the MCCI as a predictor of the short-term outcomes in a cohort of 297 patients with first-ever ischemic stroke, older than 60 years, and managed according to a clinical pathway. The poor outcome (PO) at 1 month, defined as a modified Rankin Scale score of 3-6, was the primary end point. Furthermore, a new comorbidity index has been developed, specific to our cohort, according to the same statistical approach used for the original CCI. The MCCI showed a positive association with PO (odds ratio [OR] 1.62; 95% confidence interval [CI] .98-2.68) and mortality (hazard ratio [HR] 1.85; 95% CI .94-3.61), not statistically significant and totally dependent on its association with the severity of neurologic impairment at onset. The new comorbidity index showed, as expected, a significant association with the PO and mortality with higher point estimates of OR (2.74; 95% CI 1.64-4.59) and HR (2.73; 95% CI 1.51-4.94), but this association was also dependent on stroke severity and premorbid disability. Our results do not support the validity of the MCCI as a predictor of the short-term outcomes in elderly stroke patients nor could we develop a more valid index from the available data. This suggests the need for development of disease- and age-specific indexes, possibly according to a prospective design. In any case, initial stroke severity, a strong predictor of outcome, is associated with the degree of comorbidity.
