Kidney Res Clin Pract.  2022 May;41(3):332-341. 10.23876/j.krcp.21.110.

Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy

Affiliations
  • 1Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
  • 2Data Management and Statistics Institute, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
  • 3Research Center for Chronic Disease and Environmental Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
  • 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
  • 5Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
  • 6Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
  • 7Department of Internal Medicine, Dongguk University College of Medicine, Goyang Republic of Korea

Abstract

Background
Comorbid conditions impact the survival of patients with severe acute kidney injury (AKI) who require continuous renal replacement therapy (CRRT). The weights assigned to comorbidities in predicting survival vary based on type of index, disease, and advances in management of comorbidities. We developed a modified Charlson Comorbidity Index (CCI) for use in patients with AKI requiring CRRT (mCCI-CRRT) and improved the accuracy of risk stratification for mortality. Methods: A total of 828 patients who received CRRT between 2008 and 2013, from three university hospital cohorts was included to develop the comorbidity score. The weights of the comorbidities were recalibrated using a Cox proportional hazards model adjusted for demographic and clinical information. The modified index was validated in a university hospital cohort (n = 919) using the data of patients treated from 2009 to 2015. Results: Weights for dementia, peptic ulcer disease, any tumor, and metastatic solid tumor were used to recalibrate the mCCI-CRRT. Use of these calibrated weights achieved a 35.4% (95% confidence interval [CI], 22.1%–48.1%) higher performance than unadjusted CCI in reclassification based on continuous net reclassification improvement in logistic regression adjusted for age and sex. After additionally adjusting for hemoglobin and albumin, consistent results were found in risk reclassification, which improved by 35.9% (95% CI, 23.3%–48.5%). Conclusion: The mCCI-CRRT stratifies risk of mortality in AKI patients who require CRRT more accurately than does the original CCI, suggesting that it could serve as a preferred index for use in clinical practice.

Keyword

Acute kidney injury; Charlson Comorbidity Index; Continuous renal replacement therapy; Mortality, Risk stratification
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