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Published in: BMC Neurology 1/2022

Open Access 01-12-2022 | Stroke | Research

The prognostic value of the Charlson comorbidity index in aged patients with intracerebral hemorrhage

Authors: Tianjie Zhang, Ruiqi Chen, Dingke Wen, Xing Wang, Lu Ma

Published in: BMC Neurology | Issue 1/2022

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Abstract

Background

Comorbidities are common in aged intracerebral hemorrhage patients. The purpose of this study was to assess whether the Charlson Comorbidity Index (CCI) was associated with in-hospital death and short-term functional outcome in elderly patients (age ≥ 70) with intracerebral hemorrhage (ICH).

Methods

This was a retrospective cohort of aged ICH patients (≥70 years old) admitted within 24 hours of ICH onset. The CCI was derived using hospital discharge ICD-9 CM codes and patient history obtained from standardized case report forms. Multivariable logistic regression was used to determine the independent effect of the CCI score on clinical outcomes.

Results

In this cohort of 248 aged ICH patients, comorbid conditions were common, with CCI scores ranging from 2 to 12. Logistic regression showed that the CCI score was independently predictive of 1-month functional outcome (OR = 1.642, P < 0.001) and in-hospital death (OR = 1.480, P = 0.003). Neither ICH volume nor the presence of IVH was an independent predictive factor for 1-month functional outcome or in-hospital mortality (P < 0.05).

Conclusion

Comorbid medical conditions as assessed by the CCI independently influence short-term outcomes in aged ICH patients. The characteristics of the hematoma itself, such as ICH volume and the presence of IVH, seem to have a reduced effect on it.
Literature
1.
go back to reference Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43–53.CrossRefPubMed Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43–53.CrossRefPubMed
2.
go back to reference O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet (London, England). 2010;376(9735):112–23.CrossRefPubMed O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet (London, England). 2010;376(9735):112–23.CrossRefPubMed
3.
go back to reference van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167–76.CrossRefPubMed van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010;9(2):167–76.CrossRefPubMed
4.
go back to reference Li W, Gao J, Wei S, Wang D. Application values of clinical nursing pathway in patients with acute cerebral hemorrhage. Exp Ther Med. 2016;11(2):490–4.CrossRefPubMed Li W, Gao J, Wei S, Wang D. Application values of clinical nursing pathway in patients with acute cerebral hemorrhage. Exp Ther Med. 2016;11(2):490–4.CrossRefPubMed
5.
go back to reference Inoue Y, Miyashita F, Minematsu K, Toyoda K. Clinical characteristics and outcomes of intracerebral hemorrhage in very elderly. J Stroke Cerebrovasc Dis. 2018;27(1):97–102.CrossRefPubMed Inoue Y, Miyashita F, Minematsu K, Toyoda K. Clinical characteristics and outcomes of intracerebral hemorrhage in very elderly. J Stroke Cerebrovasc Dis. 2018;27(1):97–102.CrossRefPubMed
6.
go back to reference Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke. 2009;40(2):394–9.CrossRefPubMed Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke. 2009;40(2):394–9.CrossRefPubMed
7.
go back to reference Kim MG, Gandhi C, Azizkhanian I, Epstein B, Mittal A, Lee N, et al. Frailty and spontaneous intracerebral hemorrhage: does the modified frailty index predict mortality? Clin Neurol Neurosurg. 2020;194:105816.CrossRefPubMed Kim MG, Gandhi C, Azizkhanian I, Epstein B, Mittal A, Lee N, et al. Frailty and spontaneous intracerebral hemorrhage: does the modified frailty index predict mortality? Clin Neurol Neurosurg. 2020;194:105816.CrossRefPubMed
8.
go back to reference Andaluz N, Zuccarello M. Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database. J Neurosurg. 2009;110(3):403–10.CrossRefPubMed Andaluz N, Zuccarello M. Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database. J Neurosurg. 2009;110(3):403–10.CrossRefPubMed
9.
go back to reference Liu M, Domen K, Chino N. Comorbidity measures for stroke outcome research: a preliminary study. Arch Phys Med Rehabil. 1997;78(2):166–72.CrossRefPubMed Liu M, Domen K, Chino N. Comorbidity measures for stroke outcome research: a preliminary study. Arch Phys Med Rehabil. 1997;78(2):166–72.CrossRefPubMed
10.
go back to reference Goldstein LB, Samsa GP, Matchar DB, Horner RD. Charlson index comorbidity adjustment for ischemic stroke outcome studies. Stroke. 2004;35(8):1941–5.CrossRefPubMed Goldstein LB, Samsa GP, Matchar DB, Horner RD. Charlson index comorbidity adjustment for ischemic stroke outcome studies. Stroke. 2004;35(8):1941–5.CrossRefPubMed
11.
go back to reference Tessier A, Finch L, Daskalopoulou SS, Mayo NE. Validation of the Charlson comorbidity index for predicting functional outcome of stroke. Arch Phys Med Rehabil. 2008;89(7):1276–83.CrossRefPubMed Tessier A, Finch L, Daskalopoulou SS, Mayo NE. Validation of the Charlson comorbidity index for predicting functional outcome of stroke. Arch Phys Med Rehabil. 2008;89(7):1276–83.CrossRefPubMed
13.
go back to reference Jiménez Caballero PE, López Espuela F, Portilla Cuenca JC, Ramírez Moreno JM, Pedrera Zamorano JD, Casado NI. Charlson comorbidity index in ischemic stroke and intracerebral hemorrhage as predictor of mortality and functional outcome after 6 months. J Stroke Cerebrovasc Dis. 2013;22(7):e214–8.CrossRefPubMed Jiménez Caballero PE, López Espuela F, Portilla Cuenca JC, Ramírez Moreno JM, Pedrera Zamorano JD, Casado NI. Charlson comorbidity index in ischemic stroke and intracerebral hemorrhage as predictor of mortality and functional outcome after 6 months. J Stroke Cerebrovasc Dis. 2013;22(7):e214–8.CrossRefPubMed
14.
go back to reference 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.CrossRefPubMed 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.CrossRefPubMed
15.
go back to reference Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–9.CrossRefPubMed Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–9.CrossRefPubMed
16.
go back to reference Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27(8):1304–5.CrossRefPubMed Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27(8):1304–5.CrossRefPubMed
17.
go back to reference Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, et al. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin scale. Stroke. 2002;33(9):2243–6.CrossRefPubMed Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, et al. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified Rankin scale. Stroke. 2002;33(9):2243–6.CrossRefPubMed
18.
go back to reference Yan J, Zhai W, Li Z, Ding L, You J, Zeng J, et al. ICH-LR2S2: a new risk score for predicting stroke-associated pneumonia from spontaneous intracerebral hemorrhage. J Transl Med. 2022;20(1):193.CrossRefPubMedCentralPubMed Yan J, Zhai W, Li Z, Ding L, You J, Zeng J, et al. ICH-LR2S2: a new risk score for predicting stroke-associated pneumonia from spontaneous intracerebral hemorrhage. J Transl Med. 2022;20(1):193.CrossRefPubMedCentralPubMed
19.
go back to reference Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis. 2012;21(1):61–7.CrossRefPubMed Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis. 2012;21(1):61–7.CrossRefPubMed
20.
go back to reference Koennecke HC, Belz W, Berfelde D, Endres M, Fitzek S, Hamilton F, et al. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology. 2011;77(10):965–72.CrossRefPubMed Koennecke HC, Belz W, Berfelde D, Endres M, Fitzek S, Hamilton F, et al. Factors influencing in-hospital mortality and morbidity in patients treated on a stroke unit. Neurology. 2011;77(10):965–72.CrossRefPubMed
21.
go back to reference Wan Y, Guo H, Bi R, Chen S, Shen J, Li M, et al. Clinical and prognostic characteristics of recurrent intracerebral hemorrhage: a contrast to first-ever ICH. Front Aging Neurosci. 2022;14:860571.CrossRefPubMedCentralPubMed Wan Y, Guo H, Bi R, Chen S, Shen J, Li M, et al. Clinical and prognostic characteristics of recurrent intracerebral hemorrhage: a contrast to first-ever ICH. Front Aging Neurosci. 2022;14:860571.CrossRefPubMedCentralPubMed
22.
go back to reference Rodrigues MA, ES N, Lerpiniere C, Perry LA, Moullaali TJ, JML J, et al. Association between computed tomographic biomarkers of cerebral small vessel diseases and long-term outcome after spontaneous intracerebral hemorrhage. Ann Neurol. 2021;89(2):266–79.CrossRefPubMed Rodrigues MA, ES N, Lerpiniere C, Perry LA, Moullaali TJ, JML J, et al. Association between computed tomographic biomarkers of cerebral small vessel diseases and long-term outcome after spontaneous intracerebral hemorrhage. Ann Neurol. 2021;89(2):266–79.CrossRefPubMed
23.
go back to reference Poon MT, Fonville AF, Al-Shahi SR. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014;85(6):660–7.CrossRefPubMed Poon MT, Fonville AF, Al-Shahi SR. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2014;85(6):660–7.CrossRefPubMed
24.
go back to reference Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891–7.CrossRefPubMed Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32(4):891–7.CrossRefPubMed
26.
go back to reference van Etten ES, Kaushik K, van Zwet EW, Voigt S, van Walderveen MAA, van Buchem MA, et al. Sensitivity of the Edinburgh criteria for lobar intracerebral hemorrhage in hereditary cerebral amyloid Angiopathy. Stroke. 2020;51(12):3608–12.CrossRefPubMed van Etten ES, Kaushik K, van Zwet EW, Voigt S, van Walderveen MAA, van Buchem MA, et al. Sensitivity of the Edinburgh criteria for lobar intracerebral hemorrhage in hereditary cerebral amyloid Angiopathy. Stroke. 2020;51(12):3608–12.CrossRefPubMed
27.
go back to reference Rodrigues MA, Samarasekera N, Lerpiniere C, Humphreys C, McCarron MO, White PM, et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol. 2018;17(3):232–40.CrossRefPubMedCentralPubMed Rodrigues MA, Samarasekera N, Lerpiniere C, Humphreys C, McCarron MO, White PM, et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol. 2018;17(3):232–40.CrossRefPubMedCentralPubMed
28.
go back to reference Mehndiratta P, Manjila S, Ostergard T, Eisele S, Cohen ML, Sila C, et al. Cerebral amyloid angiopathy-associated intracerebral hemorrhage: pathology and management. Neurosurg Focus. 2012;32(4):E7.CrossRefPubMed Mehndiratta P, Manjila S, Ostergard T, Eisele S, Cohen ML, Sila C, et al. Cerebral amyloid angiopathy-associated intracerebral hemorrhage: pathology and management. Neurosurg Focus. 2012;32(4):E7.CrossRefPubMed
Metadata
Title
The prognostic value of the Charlson comorbidity index in aged patients with intracerebral hemorrhage
Authors
Tianjie Zhang
Ruiqi Chen
Dingke Wen
Xing Wang
Lu Ma
Publication date
01-12-2022
Publisher
BioMed Central
Keywords
Stroke
Hematoma
Published in
BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-022-02980-z

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