title: Validity of the modified Charlson Comorbidity Index as predictor of short-term outcome in older stroke patients.
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.
authors.affiliation: Stroke Care Section, Geriatric Clinic, University Hospital of Parma, Italy. Electronic address: ldenti@ao.pr.it.
authors.forename: Licia
authors.initials: L
authors.lastname: Denti
authors.affiliation: Stroke Care Section, Geriatric Clinic, University Hospital of Parma, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Artoni
authors.affiliation: Stroke Care Section, Geriatric Clinic, University Hospital of Parma, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Casella
authors.affiliation: Stroke Care Section, Geriatric Clinic, University Hospital of Parma, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Giambanco
authors.affiliation: Neuroscience Department, University Hospital of Parma, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Scoditti
authors.affiliation: Stroke Care Section, Geriatric Clinic, University Hospital of Parma, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ceda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000150:complications*; D003704:Dementia / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*
keywords: Charlson Comorbidity Index; Ischemic stroke; old patients; outcome