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A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice

Colin J Crooks1,2, Joe West1,2, Peter Jepsen3,4

  • 1Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.

Clinical Epidemiology
|February 3, 2018
PubMed

Insights

The CirCom score slightly improves prediction of all-cause mortality in cirrhosis patients compared to the Charlson Comorbidity Index (CCI). It better predicts non-liver-related deaths, but not liver-specific mortality.

Area of Science:

  • Hepatology
  • Clinical Epidemiology
  • Biostatistics

Background:

  • The CirCom score, developed in Denmark, assesses comorbidity in cirrhosis patients to predict mortality.
  • The Charlson Comorbidity Index (CCI) is a widely used comorbidity measure.
  • Comparing these scores in an English cirrhosis population is crucial for validating their utility.

Purpose of the Study:

  • To compare the performance of the CirCom score against the Charlson Comorbidity Index (CCI) in predicting all-cause mortality in a UK cirrhosis cohort.
  • To evaluate the scores' ability to predict liver-related versus non-liver-related deaths.
  • To assess performance across different patient demographics and cirrhosis characteristics.

Main Methods:

  • A survival model was employed using comorbidity scores within the Clinical Practice Research Datalink cirrhosis cohort.
  • Model discrimination was compared using the C statistic, analyzing performance by age, gender, socioeconomic status, cirrhosis etiology, stage, and time since diagnosis.
  • The ability of each score to predict liver-related and non-liver-related mortality was specifically measured.

Main Results:

  • The CirCom score showed a marginal improvement in predictive accuracy (C statistic 0.63) over the CCI (C statistic 0.62), with a 1.5% improvement in the net reclassification index.
  • Performance improvements were more pronounced in younger patients, those with alcoholic cirrhosis, and those with compensated cirrhosis.
  • Both scores demonstrated better prediction for non-liver-related deaths (C statistic >0.7) than for liver-related deaths (C statistic <0.6).

Conclusions:

  • The CirCom score offers a slight enhancement over the CCI for predicting overall and non-liver mortality in cirrhosis patients.
  • Neither score effectively predicts liver-related mortality, indicating comorbidity is a weak predictor for this outcome.
  • Incorporating comorbidity measures alongside cirrhosis severity assessments is vital for accurate survival prediction in cirrhosis studies.
Abstract

Keywords:
cause of deathcirrhosiscohortcomorbiditymortalityprognosis

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