Value of Charlson comorbidity index in predicting the prognosis of patients with acute-on-chronic liver failure

Fuchun WANG; Wanjie ZHANG; Ziyi LI; Yongwu MAO; Aiping TIAN; Xiaorong MAO; Junfeng LI

doi:10.3969/j.issn.1001-5256.2023.05.015

Volume 39 Issue 5

May 2023

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2023 > 39(5): 1098-1104

PDF( 2205 KB)

Value of Charlson comorbidity index in predicting the prognosis of patients with acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2023.05.015

Fuchun WANG¹,
Wanjie ZHANG¹,
Ziyi LI¹,
Yongwu MAO^2a,
Aiping TIAN^2a,
Xiaorong MAO^{2a
,
,
,},
Junfeng LI^{2a, 2b
,
,
,}

1.
The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China
2a.
Department of Hepatology, The First Hospital of Lanzhou University, Lanzhou 730000, China
2b.
Research Office of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou 730000, China

Research funding:

National Natural Science Foundation of China (81800528);

Natural Science Foundation of Gansu Province (20JR5RA364);

Hospital Fund of the First Hospital of Lanzhou University (ldyyyn2020-02);

Hospital Fund of the First Hospital of Lanzhou University (ldyyyn2020-14);

Key Research and Development Project of Gansu Province (21YF5FA121);

Gansu Clinical Medical Research Center of Infection & Liver Diseases (21JR7RA392)

More Information

Corresponding author: MAO Xiaorong, mxr2013@126.com (ORCID: 0000-0003-1952-1554); LI Junfeng, junfenglee@126.com (ORCID: 0000-0002-5638-706X)
Received Date: 2022-10-13
Accepted Date: 2022-11-15
Published Date: 2023-05-20

Abstract

Abstract

Objective To investigate the value of Charlson comorbidity index (CCI) in predicting the short- and long-term risks of death in patients with acute-on-chronic liver failure (ACLF). Methods A total of 317 patients with ACLF who attended The First Hospital of Lanzhou University from December 1, 2016 to December 1, 2021 were enrolled, and according to their prognosis, they were divided into death group with 169 patients and survival group with 148 patients. The two groups were analyzed in terms of clinical data and follow-up data. The group t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The univariate and multivariate Cox proportional-hazards regression model analyses were used to investigate the influencing factors for the prognosis of ACLF patients. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparison of survival time between patients with different CCI scores. The receiver operating characteristic (ROC) curve was used to evaluate the performance of CCI and other indices in assessing the prognosis of ACLF patients. Results Among the 317 patients, there were 225 (71.0%) male patients. There were significant differences between the death group and the survival group in age, hemoglobin, white blood cell count, total bilirubin, albumin, Model for End-Stage Liver Disease (MELD) score, prothrombin time activity, CCI, age-adjusted Charlson co-morbidity index (ACCI), and follow-up time (all P < 0.05). The multivariate Cox regression analysis showed that the CCI (hazard ratio [HR]=1.351, 95% confidence interval [CI]: 1.112-1.641, P=0.002), ACCI (HR=1.200, 95%CI: 1.011-1.423, P=0.037), and MELD score (HR=1.076, 95%CI: 1.054-1.099, P < 0.001) were independent risk factors for the prognosis of ACLF patients. Based on CCI score, the patients were divided into CCI ≤4 group with 167 patients, CCI=5 group with 64 patients, and CCI ≥6 group with 86 patients, with a 3-year mortality rate of 26.5%, 83.2%, and 96.9%, respectively, and there was a significant difference in survival time between any two groups after 3 years of follow-up and at the time of follow-up till September 2022 (all P < 0.001). CCI, ACCI, and MELD scores had an area under the ROC curve of 0.845, 0.811, and 0.790, respectively, in predicting the prognosis of ACLF patients. Conclusion As commonly used comorbidity assessment indices, CCI and ACCI scores have certain value in evaluating the short- and long-term prognosis of ACLF patients.
- Acute-On-Chronic Liver Failure,
- Prognosis,
- Charlson Comorbidity Index

FullText(HTML)

References(21)

References

[1]	BAJAJ JS, O'LEARY JG, LAI JC, et al. Acute-on-chronic liver failure clinical guidelines[J]. Am J Gastroenterol, 2022, 117(2): 225-252. DOI: 10.14309/ajg.0000000000001595.
[2]	ARROYO V, MOREAU R, JALAN R. Acute-on-chronic liver failure[J]. N Engl J Med, 2020, 382(22): 2137-2145. DOI: 10.1056/NEJMra1914900.
[3]	CHARLSON ME, POMPEI P, ALES KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation[J]. J Chronic Dis, 1987, 40(5): 373-383. DOI: 10.1016/0021-9681(87)90171-8.
[4]	CHARLSON M, SZATROWSKI TP, PETERSON J, et al. Validation of a combined comorbidity index[J]. J Clin Epidemiol, 1994, 47(11): 1245-1251. DOI: 10.1016/0895-4356(94)90129-5.
[5]	TAKEMURA K, TAKENAKA Y, ASHIDA N, et al. Age-adjusted Charlson Comorbidity Index predicts prognosis of laryngopharyngeal cancer treated with radiation therapy[J]. Acta Otolaryngol, 2017, 137(12): 1307-1312. DOI: 10.1080/00016489.2017.1362112.
[6]	BOAKYE D, WALTER V, JANSEN L, et al. Magnitude of the age-advancement effect of comorbidities in colorectal cancer prognosis[J]. J Natl Compr Canc Netw, 2020, 18(1): 59-68. DOI: 10.6004/jnccn.2019.7346.
[7]	BAGNI K, CHEN IM, JOHANSEN AZ, et al. Prognostic impact of Charlson's Age-Comorbidity Index and other risk factors in patients with pancreatic cancer[J]. Eur J Cancer Care (Engl), 2020, 29(3): e13219. DOI: 10.1111/ecc.13219.
[8]	SARICI A, AR MC, YOKUS O, et al. The impact of transfusion burden and comorbidities on the prognosis of patients with myelodysplastic syndromes[J]. Transfus Apher Sci, 2020, 59(5): 102845. DOI: 10.1016/j.transci.2020.102845.
[9]	QU WF, ZHOU PY, LIU WR, et al. Age-adjusted Charlson Comorbidity Index predicts survival in intrahepatic cholangiocarcinoma patients after curative resection[J]. Ann Transl Med, 2020, 8(7): 487. DOI: 10.21037/atm.2020.03.23.
[10]	GHABRIL M, GU J, YODER L, et al. Development and validation of a model consisting of comorbidity burden to calculate risk of death within 6 months for patients with suspected drug-induced liver injury[J]. Gastroenterology, 2019, 157(5): 1245-1252. DOI: 10.1053/j.gastro.2019.07.006.
[11]	SHINKAWA H, TANAKA S, TAKEMURA S, et al. Predictive value of the age-adjusted Charlson comorbidity index for outcomes after hepatic resection of hepatocellular carcinoma[J]. World J Surg, 2020, 44(11): 3901-3914. DOI: 10.1007/s00268-020-05686-w.
[12]	Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007. 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
[13]	KAHL A, DU BOIS A, HARTER P, et al. Prognostic value of the age-adjusted Charlson comorbidity index (ACCI) on short- and long-term outcome in patients with advanced primary epithelial ovarian cancer[J]. Ann Surg Oncol, 2017, 24(12): 3692-3699. DOI: 10.1245/s10434-017-6079-9.
[14]	BECKER C, DAHLEM K, LANGE K, et al. Predictive value of comorbidity and anemia on outcome in patients with sinonasal carcinoma[J]. J Craniomaxillofac Surg, 2018, 46(8): 1373-1378. DOI: 10.1016/j.jcms.2018.05.009.
[15]	FORMIGA F, MORENO-GONZALEZ R, CHIVITE D, et al. High comorbidity, measured by the Charlson Comorbidity Index, associates with higher 1-year mortality risks in elderly patients experiencing a first acute heart failure hospitalization[J]. Aging Clin Exp Res, 2018, 30(8): 927-933. DOI: 10.1007/s40520-017-0853-1.
[16]	FRACCARO P, KONTOPANTELIS E, SPERRIN M, et al. Predicting mortality from change-over-time in the Charlson Comorbidity Index: A retrospective cohort study in a data-intensive UK health system[J]. Medicine (Baltimore), 2016, 95(43): e4973. DOI: 10.1097/MD.0000000000004973.
[17]	RATTANASOMPATTIKUL M, FEROZE U, MOLNAR MZ, et al. Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients[J]. Int Urol Nephrol, 2012, 44(6): 1813-1823. DOI: 10.1007/s11255-011-0085-9.
[18]	LI H, ZHENG J, CHEN L, et al. The scoring systems in predicting short-term outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Ann Palliat Med, 2020, 9(5): 3048-3058. DOI: 10.21037/apm-20-608.
[19]	XU Y, HUANG XP, CHEN L, et al. Value of high-density lipoprotein cholesterol in evaluating the severity and prognosis of hepatitis B virus-associated acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(7): 1632-1635. DOI: 10.3969/j.issn.1001-5256.2021.07.030. 徐英, 黄小平, 陈丽, 等. 高密度脂蛋白胆固醇对HBV相关慢加急性肝衰竭严重程度及预后的预测价值[J]. 临床肝胆病杂志, 2021, 37(7): 1632-1635. DOI: 10.3969/j.issn.1001-5256.2021.07.030.
[20]	XU X, HOU Z, XU Y, et al. The dynamic of platelet count as a novel and valuable predictor for 90-day survival of hepatitis B virus-related acute-on-chronic liver failure patients[J]. Clin Res Hepatol Gastroenterol, 2021, 45(2): 101482. DOI: 10.1016/j.clinre.2020.06.008.
[21]	CHAN TC, LUK JK, CHU LW, et al. Validation study of Charlson Comorbidity Index in predicting mortality in Chinese older adults[J]. Geriatr Gerontol Int, 2014, 14(2): 452-457. DOI: 10.1111/ggi.12129.

Relative Articles

Supplements(0)

Cited By

Cited by

Periodical cited type(1)

徐大洲，张树贤，王坤，左晨艳，曾毅，袁青文，张志梅. 血清簇集蛋白、1-磷酸鞘氨醇水平对脓毒症急性肝损伤患者的预后价值. 临床肝胆病杂志. 2023(12): 2867-2872 .

本站查看

Other cited types(3)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(3) / Tables(5)

Get Citation

PDF

XML

Article Metrics

Article views (659) PDF downloads(68)

Value of Charlson comorbidity index in predicting the prognosis of patients with acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2023.05.015