Charlson Comorbidity Index (CCI)

Determines the 10-year survival in patients suffering from multiple comorbidities.

In the text below the calculator there are instructions on how the index score is calculated and information about the original study.


The Charlson comorbidity index evaluates the survival/mortality risk for the next 10 years in patients who suffer from several conditions such as congestive heart failure or diabetes.

It is aimed at simplifying decision making for medical specialists, regarding different screenings and procedures that the patient might or might not live to benefit from.

It consists of 17 items, one of which is the patient age and the others are comorbidities that are weighted differently in the score.


Each of the items in the index is awarded a number of points which are then summed:

■ 1 point conditions – Myocardial infarction, congestive heart failure, peripheral vascular disease, dementia, cerebrovascular disease, connective tissue disease, ulcer, chronic liver disease, diabetes mellitus.

■ 2 point conditions - Hemiplegia, moderate to severe kidney disease, diabetes mellitus with end organ damage, solid tumor, leukemia, lymphoma.

■ 3 point condition - Moderate to severe liver disease.

■ 6 point conditions - Malignant tumor, metastasis, AIDS.

S is the result from summing the points.

CCI ten year survival = 0.983where A = e (S x 0.9)


1Patient Age
2Myocardial Infarction
3Congestive Heart Failure
4Peripheral Vascular Disease
5Cerebrovascular Disease
6Dementia
7COPD
8Connective Tissue Disease
9Peptic Ulcer Disease
10Diabetes Mellitus
11Moderate to severe Chronic Kidney Disease
12Hemiplegia
13Leukemia
14Malignant Lymphoma
15Solid Tumor
16Liver Disease
17AIDS
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Charlson comorbidity index explained

The CCI is a survival stratification tool that assesses the comorbidity risk associated with several conditions.

It allows medical specialists to make informed decisions in regard to procedures that patients may or not benefit from.

The CCI basically predicts the ten-year survival, therefore informing the medical specialist about how the comorbidities the patient is suffering from impact their life expectancy, thus helping them decide upon the short and long term benefits of the treatment they are about to recommend.

Comorbidities of patients are defined using the International Classification of Diseases (ICD) diagnosis codes.

Comorbidity is defined as the presence of one or more additional conditions existing simultaneously, independently or not (with or without a causal effect) with a disease that is considered primary.

In the CCI the patient’s age is allocated to one of the age groups, each considered to be of a different risk.

The following table introduces the conditions used in the comorbidity index and the number of points they are awarded:

Charlson index item Points Other notes
Myocardial Infarction (MI) 1 commonly heart attack, either patient or family history
Congestive Heart Failure (CHF) 1 high output cardiac failure
Peripheral Vascular Disease (PVD) 1 peripheral artery occlusive disease and peripheral obliterative arteriopathy
Cerebrovascular Disease (CVA) 1 impaired mental processes with memory loss
Dementia 1 -
Chronic Obstructive Pulmonary Disease (COPD) 1 pulmonary disease
Connective Tissue Disease 1 group of diseases affecting the bodies connective tissue such as fat, bone or cartilage
Peptic Ulcer Disease 1 ulceration of the stomach and/ or first part of the small intestine lining
Diabetes Mellitus 1 or 2 score of 1 for uncomplicated and 2 for end organ damage
Chronic Kidney Disease (CKD) 2 impaired renal function to different degrees (moderate to severe)
Hemiplegia 2 weakness of one entire half side of the body, consequence or not of stroke
Leukemia 2 malignancy consisting in increased number of immature and/or abnormal leucocytes
Malignant Lymphoma 2 cancerous spread in the lymph system
Solid tumor 2 or 6 2 in case of presence and 6 in case tumor is metastatic
Liver disease 1 or 3 hepatic function damage caused by alcohol, viral or genetic agents (mild 1 point, moderate to severe 3 points)
AIDS 6 Acquired Immune Deficiency Syndrome caused by the Human Immunodeficiency Virus (HIV)
 

CCI scoring

As described in the table above, each of the items in the CCI is awarded a number of points, which are summed according to the answers about the patient. The index score is further calculated through the following method, which is also used in the CCI calculator:

S – result from point addition

CCI ten year survival = 0.983where A = e (S x 0.9)

As an example, for a CCI score of 6, the ten year survival is 2.25%.

 

About the study

The index was created by Charlson et al. in 1987 following a study initially on a cohort of 559 medical patients for the 1-year survival and then on a cohort of 685 patients for the 10-year survival method.

It was aimed at usage within longitudinal studies that involved conditions which might alter the risk of mortality.

The CCI was found to perform similarly to a previous system devised by Kaplan and Feinstein.

A subsequent validation study was performed on 226 patients with hypertension or diabetes who underwent elective surgery.

In time there have been built different variations such as the Charlson-Deyo, Charlson-Romano, Charlson-Manitoba and Charlson-D'Hoores comorbidity indices.

 

Original study

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83.

Validation

Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994; 47(11):1245-51.


App Version: 1.0.1

Coded By: MDApp

Specialty: Emergency

Objective: Survival Stratification

Type: Index

No. Of Items: 17

Year Of Study: 1987

Abbreviation: CCI

Article By: Denise Nedea

Published On: April 5, 2017 · 10:10 AM

Last Checked: April 5, 2017

Next Review: April 5, 2018