Abstract: FR-PO508

Recalibration and Validation of the Charlson Comorbidity Index in an Asian Population: The National Health Insurance Service – National Sample Cohort Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Choi, Jae shin, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Lee, Jung Pyo, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)
  • Kim, Myoung-Hee, Eulji University , Seongnam-si, Gyeonggi-do, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • An, Jung Nam, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)
  • Park, Jae Yoon, Dongguk University Ilsan Hospital, Gyeonggido, Korea (the Republic of)
  • Kim, Dong Ki, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Oh, Yun Kyu, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital, Seoul, Korea (the Republic of)
  • Lim, Chun Soo, Seoul National University Boramae Medical Center, Seoul, SEOUL, Korea (the Republic of)
Background

Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in an Asian nationwide database (mCCI-A), thereby predicting their mortality more precisely.

Methods

The main data source used in this study was the National Health Insurance Service-National Sample Cohort (NHIS-NSC) constructed from the National Health Insurance database, which includes health insurance claims between January 1, 2002 and December 31, 2013 in Korea. Of the 1,025,340 individuals included in the NHIS-NSC, 578,547 patients who were hospitalized at least once were analyzed for this study. mCCI-A score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazard model. The modified index was validated in the same cohort.

Results

The Cox proportional hazards model provided reassigned severity weights for 17 comorbidities that significantly predicted mortality. Both the CCI and the mCCI-A were correlated with mortality. However, the mCCI-A showed modest but significant increases in c statistics compared with the CCI. The analyses using continuous net reclassification improvement(cNRI) revealed that the mCCI-A improved net mortality risk reclassification by 23.1% (95% CI, 22.0-24.3; P<0.001).

Conclusion

The mCCI-A facilitates better risk stratification for mortality in Korean inpatients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies.