title: Charlson comorbidity index as a predictor of in-hospital death in acute ischemic stroke among very old patients: a single-cohort perspective study.
abstract: Chronic diseases are increasing worldwide. Association of two or more chronic conditions is related with poor health status and reduced life expectancy, particularly among elderly patients. Comorbidities represent a risk factor for adverse events in several critical illnesses. We aimed to evaluate if elderly patients are affected by multiple chronic pathologies, assessed by Charlson comorbidity index (CCI), showed a reduced in-hospital survival after ischemic stroke. In a 3-year period, we evaluated all the subjects admitted to our internal medicine department for ischemic stroke. Age, sex, NIHSS score and all the comorbidities were recorded. Days of hospitalization, hospital-related infections and in-hospital mortality were also assessed. For each patient, we evaluated CCI, obtaining four classes: group 1 (CCI: 2-3), group 2 (CCI: 4-5), group 3 (CCI: 6-7) and group 4 (CCI: ≥8). Survival was evaluated with Kaplan-Meier and Cox regression analyses. The complete model considered in-hospital death as the main outcome, days of hospitalization as the time variable and CCI as the main predictor, adjusting for NIHSS, sex and nosocomial infections. Patients in CCI group 3 and 4 had an increased risk of in-hospital mortality, independently of NIHSS, sex and nosocomial infections. Elderly patients with multiple comorbidities have higher risk of in-hospital death when affected by ischemic stroke.
authors.affiliation: Internal and Sub-intensive Medicine Department, A.O.U. "Ospedali Riuniti", Via Conca no. 10, Ancona, Italy. drfalsetti@yahoo.it.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Falsetti
authors.affiliation: Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Viticchi
authors.affiliation: Department of Internal Medicine, Ospedali "Santa Casa", Loreto (AN) e "S.S. Benvenuto e Rocco", Osimo, Ancona, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Tarquinio
authors.affiliation: Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Silvestrini
authors.affiliation: Department of Internal Medicine, Ospedali "Santa Casa", Loreto (AN) e "S.S. Benvenuto e Rocco", Osimo, Ancona, Italy.
authors.forename: William
authors.initials: W
authors.lastname: Capeci
authors.affiliation: Department of Internal Medicine, Ospedali "Santa Casa", Loreto (AN) e "S.S. Benvenuto e Rocco", Osimo, Ancona, Italy.
authors.forename: Vania
authors.initials: V
authors.lastname: Catozzo
authors.affiliation: Department of Internal Medicine, Ospedali "Santa Casa", Loreto (AN) e "S.S. Benvenuto e Rocco", Osimo, Ancona, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Fioranelli
authors.affiliation: Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Buratti
authors.affiliation: Department of Internal Medicine, Ospedali "Santa Casa", Loreto (AN) e "S.S. Benvenuto e Rocco", Osimo, Ancona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pellegrini
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality*
keywords: Charlson comorbidity index; Elderly patient; Ischemic stroke; Multimorbidity