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News

Comorbidity scoring system for patients with cirrhosis

A team of doctors developed and validated a comorbidity scoring system for patients with cirrhosis, reports January's Gastroenterology.

News image

At least 40% of patients with cirrhosis have comorbidities that increase mortality.

Dr Peter Jepsen and colleagues developed a cirrhosis-specific comorbidity scoring system (CirCom) to help determine how these comorbidities affect mortality and compared it with the generic Charlson Comorbidity Index.

The team used data from nationwide health care registries to identify Danish citizens diagnosed with cirrhosis in 1999−2008.

The citizens were followed through 2010 and characterized by 34 comorbidities.

The researchers used Cox regression to assign severity weights to comorbidities with an adjusted mortality hazard ratio ≥1.20.

Each patient's CirCom score was based on, at most, 2 of these comorbidities.

Performance was measured with Harrell's C statistic and the Net Reclassification Index (NRI), and results were compared with those obtained using the Charlson Index.

24% of patients had 1 or more of the risk factors
Gastroenterology

Findings were validated in 2 separate cohorts of patients with alcohol-related cirrhosis or chronic hepatitis C.

The CirCom score included chronic obstructive pulmonary disease, acute myocardial infarction, peripheral arterial disease, epilepsy, substance abuse, heart failure, nonmetastatic cancer, metastatic cancer, and chronic kidney disease.

The research team found that 24% of patients had 1 or more of these, and mortality correlated with the CirCom score.

The team observed that patients' CirCom score correlated with their Charlson Comorbidity Index.

Compared with the Charlson Index, the team noted that the CirCom score increased Harrell's C statistic by 0.6%.

The NRI for the CirCom score was 5%, and the NRI for the Charlson Index was 4%.

The research team obtained similar results from the validation cohorts.

Dr Jepsen's team concludes, "We developed a scoring system to predict mortality among patients with cirrhosis based on 9 comorbidities."

"This system had higher C statistic and NRI values than the Charlson Comorbidity Index, and is easier to use."

"It could therefore be a preferred method to predict death or survival of patients and for use in epidemiologic studies."

Gastroenterology 2014: 146(1): 147-156
20 December 2013

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