How I assess comorbidities before hematopoietic cell transplantation

Abstract

The hematopoietic cell transplantationcomorbidity index (HCT-CI) is a comorbidity tool suited for recipients of HCT. The index has been shown to sensitively capture the prevalence and magnitude of severity of various organ impairments before HCT and to provide valuable prognostic information after HCT. Many investigators have validated the discriminative power of the HCT-CI, but others have not. One concern is the consistency in comorbidity coding across different evaluators, particularly in view of the relatively recent addition of the HCT-CI to the transplant evaluation process. In this article, comorbidity scoring was tested across different evaluators, and only a fair interobserver agreement rate could be detected. To address these issues, a brief training program is proposed here, consisting of systematic methodology for data acquisition and consistent guidelines for comorbidity coding that were summarized in a Webbased calculator. In a validation patient cohort, this training program was shown to improve the interevaluator agreement on HCT-CI scores to an excellent rate with weighted k values in the range of 0.89 to 0.97. This proposed training program will facilitate reliable assessment of comorbidities in the clinic and for research studies leading to standardization of the use of comorbidities in prediction of HCT outcomes. (Blood. 2013;121(15):2854-2863 IntroductionOrgan dysfunctions (comorbidities) were found to be associated with the outcome of treatment of a given primary disease 1,2 and, in particular, cancer. 3,4 In 2005, a hematopoietic cell transplantationcomorbidity index (HCT-CI) was introduced as a measure of organ dysfunctions that was suited for recipients of HCT. 5 The HCT-CI was developed from the historical Charlson comorbidity index 6 after introducing 3 conceptual changes: the use of laboratory and organ function tests to redefine pulmonary, hepatic, cardiac, and renal comorbidities; the inclusion of all comorbidities encountered in a cohort of HCT recipients at a single institution; and the estimation of new adjusted hazard ratios for the associations between comorbidities and nonrelapse mortality after HCT. These adjusted hazard ratios were then converted into weights that could be summated into a total score.In validation cohorts of recipients of allogeneic HCT from 2 different institutions, the HCT-CI was demonstrated to have higher discriminative power than the Charlson comorbidity index, both for non-relapse mortality and overall survival. 5,7 Many investigators reported on the valid association between HCT-CI scores and mortality in their respective single-institutions, [8][9][10][11][12][13][14][15][16][17] whereas a few others disagreed. [18][19][20][21][22] A discussion of the possible reasons for the lack of complete agreement by investigators on the validity of the HCT-CI is outside the scope of this article. Instead, the focus of this article is a single concern that is related to the degree of consistency in assigning comorbidity scores among evaluators. For example, a r...

Clinical profile, biological markers, and comorbidity index as predictors of transplant-related mortality after allo-HSCT

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