Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy
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...
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| Format: | Article |
| Language: | English |
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The Korean Society of Nephrology
2022-05-01
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| Series: | Kidney Research and Clinical Practice |
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| Online Access: | http://www.krcp-ksn.org/upload/pdf/j-krcp-21-110.pdf |
| _version_ | 1828289874970542080 |
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| author | Jinwoo Lee Jiyun Jung Jangwook Lee Jung Tak Park Chan-Young Jung Yong Chul Kim Dong Ki Kim Jung Pyo Lee Sung Jun Shin Jae Yoon Park |
| author_facet | Jinwoo Lee Jiyun Jung Jangwook Lee Jung Tak Park Chan-Young Jung Yong Chul Kim Dong Ki Kim Jung Pyo Lee Sung Jun Shin Jae Yoon Park |
| author_sort | Jinwoo Lee |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T10:27:53Z |
| format | Article |
| id | doaj.art-e507f6326dd247328fe3bc2baef314f3 |
| institution | Directory Open Access Journal |
| issn | 2211-9132 2211-9140 |
| language | English |
| last_indexed | 2024-04-13T10:27:53Z |
| publishDate | 2022-05-01 |
| publisher | The Korean Society of Nephrology |
| record_format | Article |
| series | Kidney Research and Clinical Practice |
| spelling | doaj.art-e507f6326dd247328fe3bc2baef314f32022-12-22T02:50:16ZengThe Korean Society of NephrologyKidney Research and Clinical Practice2211-91322211-91402022-05-0141333234110.23876/j.krcp.21.1106112Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapyJinwoo Lee0Jiyun Jung1Jangwook Lee2Jung Tak Park3Chan-Young Jung4Yong Chul Kim5Dong Ki Kim6Jung Pyo Lee7Sung Jun Shin8Jae Yoon Park9 Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea Data Management and Statistics Institute, Dongguk University Ilsan Hospital, Goyang, Republic of Korea Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of KoreaBackground 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.http://www.krcp-ksn.org/upload/pdf/j-krcp-21-110.pdfacute kidney injurycharlson comorbidity indexcontinuous renal replacement therapymortalityrisk assessment |
| spellingShingle | Jinwoo Lee Jiyun Jung Jangwook Lee Jung Tak Park Chan-Young Jung Yong Chul Kim Dong Ki Kim Jung Pyo Lee Sung Jun Shin Jae Yoon Park Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy Kidney Research and Clinical Practice acute kidney injury charlson comorbidity index continuous renal replacement therapy mortality risk assessment |
| title | Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy |
| title_full | Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy |
| title_fullStr | Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy |
| title_full_unstemmed | Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy |
| title_short | Recalibration and validation of the Charlson Comorbidity Index in acute kidney injury patients underwent continuous renal replacement therapy |
| title_sort | recalibration and validation of the charlson comorbidity index in acute kidney injury patients underwent continuous renal replacement therapy |
| topic | acute kidney injury charlson comorbidity index continuous renal replacement therapy mortality risk assessment |
| url | http://www.krcp-ksn.org/upload/pdf/j-krcp-21-110.pdf |
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