Charlson Comorbidity Index and other predictors of in-hospital mortality among adults with community-acquired pneumonia

Bahlis, Laura Fuchs; Diogo, Luciano Passamani

doi:10.36416/1806-3756/e20200257

Cited by 17 publications

(15 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When evaluating the sensitivity and specificity for AKI of the scores studied, it was observed that all three scores had low predictive discrimination. However, although CCI is presented as a good prediction tool for other problems (15)(16) , in this study a worse performance was observed when it was compared to the other two, thus not being a good prediction tool for this variable. The SOFA score was considered superior when compared to other scores to describe complications in critically ill patients with AKI in ICU (12) .…”

Section: Discussioncontrasting

confidence: 59%

Predictive capacity of prognostic scores for kidney injury, dialysis, and death in intensive care units

Vasconcelos

Magro

Fonseca

et al. 2021

Rev. esc. enferm. USP

View full text Add to dashboard Cite

Objective: To assess the capacity of Charlson, SAPS 3 and SOFA scores to predict acute kidney injury, need for dialysis, and death in intensive care unit patients. Method: Prospective cohort, with 432 individuals admitted to four intensive care units. Clinical characteristics at admission, severity profile, and intensity of care were analyzed using association and correlation tests. The scores sensitivity and specificity were assessed using the ROC curve. Results: The results show that patients with acute kidney injury were older (65[27] years vs. 60[25] years, p = 0.019) and mostly are from the emergency department (57.9% vs. 38.0 %, p < 0.001), when compared to those in the group without acute kidney injury. For dialysis prediction, the results of SAPS 3 and SOFA were AUC: 0.590; 95%CI: 0.507–0.674; p-value: 0.032 and AUC: 0.667; 95%CI: 0.591–0.743; p-value: 0.000, respectively. All scores performed well for death. Conclusion: The prognostic scores showed good capacity to predict acute kidney injury, dialysis, and death. Charlson Comorbidity Index showed good predictive capacity for acute kidney injury and death; however, it did not perform well for the need for dialysis.

show abstract

Section: Discussioncontrasting

confidence: 59%

Predictive capacity of prognostic scores for kidney injury, dialysis, and death in intensive care units

Vasconcelos

Magro

Fonseca

et al. 2021

Rev. esc. enferm. USP

View full text Add to dashboard Cite

show abstract

“…Regarding severity, the utility of the SAPS II score among long-term outcomes is still debatable [28]. On top of that, other scores as the higher Charlson comorbidity Index, are associated with higher mortality during hospitalisation due to CAP [29]. Still, some medical conditions included in this score have been individually associated with worse long-term clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: A targeted maximum likelihood estimation and survival analysis

Reyes

García

Ibáñez-Prada

et al. 2023

Preprint

View full text Add to dashboard Cite

Introduction: Patients with community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU) have high mortality rates during the acute infection and up to ten years thereafter. Recommendations from international CAP guidelines include macrolide-based treatment. However, there is no data on the long-term outcomes of this recommendation. Therefore, we aimed to determine the impact of macrolide-based therapy on long-term mortality in this population. Methods Registered patients in the MIMIC-IV database 16 years or older and admitted to the ICU due to CAP were included. Multivariate analysis, targeted maximum likelihood estimation (TMLE) to simulate a randomised controlled trial, and survival analyses were conducted to test the effect of macrolide-based treatment on mortality six-month [6m] and twelve-month [12m] after hospital admission. A sensitivity analysis was performed excluding patients with Pseudomonas aeruginosa or MRSA pneumonia to control for Healthcare-Associated Pneumonia (HCAP). Results 3775 patients were included, and 1154 were treated with a macrolide-based treatment. The non-macrolide-based group had worse long-term clinical outcomes, represented by 6m (31.5 [363/1154] vs 39.5 [1035/2621], p < 0.001) and 12m mortality (39.0 [450/1154] vs 45.7 [1198/2621], p < 0.001). The main risk factors associated with long-term mortality were Charlson comorbidity index, SAPS II, septic shock, and respiratory failure. Macrolide-based treatment reduced the risk of dying at 6m (HR [95% CI] 0.69 [0.60, 0.78], p < 0.001) and 12m (0.72 [0.64, 0.81], p < 0.001]). After TMLE, the protective effect continued with an additive effect estimate of -0.069. Conclusion Macrolide-based treatment reduced the hazard risk of long-term mortality by almost one-third. This effect remains after simulating an RCT with TMLE and the sensitivity analysis for the HCAP classification.

show abstract

“…Regarding severity, the utility of the SAPS II score among long-term outcomes is still debatable [ 30 , 31 ]. On top of that, other scores as the higher Charlson comorbidity Index, are associated with higher mortality during hospitalisation due to CAP [ 32 ]. Still, some medical conditions included in this score have been individually associated with worse long-term clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: a targeted maximum likelihood estimation and survival analysis

et al. 2023

View full text Add to dashboard Cite

Introduction Patients with community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU) have high mortality rates during the acute infection and up to ten years thereafter. Recommendations from international CAP guidelines include macrolide-based treatment. However, there is no data on the long-term outcomes of this recommendation. Therefore, we aimed to determine the impact of macrolide-based therapy on long-term mortality in this population. Methods Registered patients in the MIMIC-IV database 16 years or older and admitted to the ICU due to CAP were included. Multivariate analysis, targeted maximum likelihood estimation (TMLE) to simulate a randomised controlled trial, and survival analyses were conducted to test the effect of macrolide-based treatment on mortality six-month (6 m) and twelve-month (12 m) after hospital admission. A sensitivity analysis was performed excluding patients with Pseudomonas aeruginosa or MRSA pneumonia to control for Healthcare-Associated Pneumonia (HCAP). Results 3775 patients were included, and 1154 were treated with a macrolide-based treatment. The non-macrolide-based group had worse long-term clinical outcomes, represented by 6 m [31.5 (363/1154) vs 39.5 (1035/2621), p < 0.001] and 12 m mortality [39.0 (450/1154) vs 45.7 (1198/2621), p < 0.001]. The main risk factors associated with long-term mortality were Charlson comorbidity index, SAPS II, septic shock, and respiratory failure. Macrolide-based treatment reduced the risk of dying at 6 m [HR (95% CI) 0.69 (0.60, 0.78), p < 0.001] and 12 m [0.72 (0.64, 0.81), p < 0.001]. After TMLE, the protective effect continued with an additive effect estimate of − 0.069. Conclusion Macrolide-based treatment reduced the hazard risk of long-term mortality by almost one-third. This effect remains after simulating an RCT with TMLE and the sensitivity analysis for the HCAP classification.

show abstract

Charlson Comorbidity Index and other predictors of in-hospital mortality among adults with community-acquired pneumonia

Cited by 17 publications

References 25 publications

Predictive capacity of prognostic scores for kidney injury, dialysis, and death in intensive care units

Predictive capacity of prognostic scores for kidney injury, dialysis, and death in intensive care units

Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: A targeted maximum likelihood estimation and survival analysis

Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: a targeted maximum likelihood estimation and survival analysis

Contact Info

Product

Resources

About