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Published on: September 22, 2020
Prognostic Value of Charlson Comorbidity Index in Acute Embolic Lower Limb Ischaemia Patients
Vânia Constâncio Oliveira1, Pedro Oliveira2, Mafalda Correia1
1Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Insights
The Charlson Comorbidity Index (CCI), both unadjusted (CCIu) and age-adjusted (CCIa), effectively predicts major amputation and mortality in acute embolic lower limb ischaemia (AELLI) patients. These validated scores offer valuable prognostic insights for AELLI outcomes.
Area of Science:
- Vascular Surgery
- Outcome Research
- Epidemiology
Background:
- The Charlson Comorbidity Index (CCI) is widely used for adjusting outcome studies based on patient comorbidities.
- However, the CCI has not been specifically validated for acute embolic lower limb ischaemia (AELLI).
Purpose of the Study:
- To evaluate if a high unadjusted CCI (CCIu) and age-adjusted CCI (CCIa) predict major amputation and mortality after a first AELLI episode.
- To validate the discriminating ability of CCIu and CCIa in predicting AELLI outcomes.
Main Methods:
- Retrospective evaluation of 100 first-episode AELLI patients undergoing embolectomy.
- Calculation of CCIu and CCIa, followed by Cox regression and ROC curve analysis for survival prediction.
- Kaplan-Meier survival analysis and Log-Rank tests were used to assess differences in survival curves.
Main Results:
- High CCIu (≥3) and CCIa (≥6) scores were significantly associated with increased amputation rates and mortality (30-day and long-term).
- Multivariate analysis confirmed both CCIu and CCIa as independent predictors of amputation and 30-day mortality.
- Amputation rate was 16%, 30-day mortality 21%, and long-term mortality 42% in the study cohort.
Conclusions:
- Both unadjusted (CCIu) and age-adjusted (CCIa) Charlson Comorbidity Index scores are valuable prognostic factors in AELLI.
- These validated CCI scores can predict amputation rates and survival in patients with a first AELLI event.
Introduction:
Charlson Comorbidity Index (CCI) is commonly used in outcome studies to adjust for patient comorbid conditions but has not been specifically validated for use in acute embolic lower limb ischaemia (AELLI).
Objectives:
The aim of this study was to access whether a high CCI score unadjusted (CCIu) and adjusted (CCIa) by age relates to major amputation and mortality after a first episode of AELLI.
Methods:
The last 100 patients presenting with the first event of AELLI submitted to embolectomy at our Vascular Surgery Department were retrospectively evaluated. Patient characteristics, pre- and post-operative period variables were collected and CCIu and CCIa calculated. Survival predictors were analyzed using Cox regression. The area under the curve of the receiver operating characteristic curves was calculated to validate and determine the discriminating ability of CCIu and CCIa in predicting amputation rate and 30-day mortality. Youden index was used to determine the critical value. Survival analysis was performed with Kaplan-Meier method and differences between survival curves were tested with Log-Rank test. A P value of <0.05 was considered statistically significant.
Results:
The mean age was 80.03±10.776 years and the mean follow-up 19.28±7.929 months. Amputation rate was 16%, 30-day mortality 21% and long-term mortality 42%. Patients with CCIu≥3 compared with patients with CCIu<3 had higher amputation rate (37.5% vs. 1.7%; OR:35.400), 30-day mortality (47.5% vs. 3.3%; OR:35.400) and global mortality (P=0.00). Also, patients with CCIa≥6 compared with patients with CCIa<6 had higher amputation rate (34.1% vs. 1.8%; OR:28.488), 30-day mortality (47.7% vs. 0.0%) and global mortality (P=0.00). Multivariate analysis showed that both CCIu and CCIa were independent predictors of amputation rate and 30-day mortality.
Conclusion:
CCIu and CCIa have proven to be good predictors of amputation rate and survival, thus being a valuable prognostic factor in patients presenting with the first event of AELLI.
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