Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients

Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators

Research output: Contribution to journalArticle

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Abstract

Background: Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in incident hemodialysis patients (mCCI-IHD), thereby improving risk stratification for mortality. Methods: Data on 24,738 Koreans who received their first hemodialysis treatment between 2005 and 2008 were obtained from the Korean Health Insurance dataset. The mCCI-IHD score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazards model. The modified index was validated in an independent nationwide prospective cohort (n=1,100). Results: The Cox proportional hazards model revealed that all comorbidities in the CCI except ulcers significantly predicted mortality. Thus, the mCCI-IHD included 14 comorbidities with reassigned severity weights. In the validation cohort, both the CCI and the mCCI-IHD were correlated with mortality. However, the mCCI-IHD showed modest but significant increases in c statistics compared with the CCI at 6 months and 1 year. The analyses using continuous net reclassification improvement revealed that the mCCI-IHD improved net mortality risk reclassification by 24.6% (95% CI, 2.5-46.7; P=0.03), 26.2% (95% CI, 1.0-51.4; P=0.04) and 42.8% (95% CI, 4.9-80.8; P=0.03) with respect to the CCI at 6 months and 1 and 2 years, respectively. Conclusions: The mCCI-IHD facilitates better risk stratification for mortality in incident hemodialysis patients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies.

Original languageEnglish
Article numbere0127240
JournalPloS one
Volume10
Issue number5
DOIs
Publication statusPublished - 2015 May 18

Fingerprint

hemodialysis
Renal Dialysis
Comorbidity
Hazards
Health insurance
Mortality
Statistical methods
Statistics
taxonomic revisions
Proportional Hazards Models
Weights and Measures
disability weights
comorbidity
health insurance
Health Insurance
epidemiological studies
Ulcer
Epidemiologic Studies
statistical analysis
statistics

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators (2015). Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients. PloS one, 10(5), [e0127240]. https://doi.org/10.1371/journal.pone.0127240
Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators. / Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients. In: PloS one. 2015 ; Vol. 10, No. 5.
@article{adaffa39848c436fa1709c32d833c4eb,
title = "Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients",
abstract = "Background: Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in incident hemodialysis patients (mCCI-IHD), thereby improving risk stratification for mortality. Methods: Data on 24,738 Koreans who received their first hemodialysis treatment between 2005 and 2008 were obtained from the Korean Health Insurance dataset. The mCCI-IHD score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazards model. The modified index was validated in an independent nationwide prospective cohort (n=1,100). Results: The Cox proportional hazards model revealed that all comorbidities in the CCI except ulcers significantly predicted mortality. Thus, the mCCI-IHD included 14 comorbidities with reassigned severity weights. In the validation cohort, both the CCI and the mCCI-IHD were correlated with mortality. However, the mCCI-IHD showed modest but significant increases in c statistics compared with the CCI at 6 months and 1 year. The analyses using continuous net reclassification improvement revealed that the mCCI-IHD improved net mortality risk reclassification by 24.6{\%} (95{\%} CI, 2.5-46.7; P=0.03), 26.2{\%} (95{\%} CI, 1.0-51.4; P=0.04) and 42.8{\%} (95{\%} CI, 4.9-80.8; P=0.03) with respect to the CCI at 6 months and 1 and 2 years, respectively. Conclusions: The mCCI-IHD facilitates better risk stratification for mortality in incident hemodialysis patients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies.",
author = "{Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators} and Park, {Jae Yoon} and Kim, {Myoung Hee} and Han, {Seung Seok} and Hyunjeong Cho and Ho Kim and Ryu, {Dong Ryeol} and Hyunwook Kim and Hajeong Lee and Lee, {Jung Pyo} and Lim, {Chun Soo} and Kim, {Kyoung Hoon} and Joo, {Kwon Wook} and Kim, {Yon Su} and Kim, {Dong Ki} and Do, {J. Y.} and Song, {S. H.} and Kim, {S. E.} and Kim, {S. H.} and Kim, {Y. H.} and Lee, {J. S.} and Jin, {H. J.} and Lim, {C. S.} and Lee, {J. P.} and Chang, {J. H.} and TaeHyun Yoo and Park, {J. T.} and Oh, {H. J.} and Park, {H. C.} and Chang, {T. I.} and Ryu, {D. R.} and Oh, {D. J.} and Chang, {Y. S.} and Kim, {Y. O.} and Kim, {S. H.} and Jin, {D. C.} and Kim, {Y. K.} and Kim, {H. Y.} and W. Kim and Lee, {K. W.} and Lee, {C. S.}",
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Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators 2015, 'Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients', PloS one, vol. 10, no. 5, e0127240. https://doi.org/10.1371/journal.pone.0127240

Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients. / Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators.

In: PloS one, Vol. 10, No. 5, e0127240, 18.05.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients

AU - Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators

AU - Park, Jae Yoon

AU - Kim, Myoung Hee

AU - Han, Seung Seok

AU - Cho, Hyunjeong

AU - Kim, Ho

AU - Ryu, Dong Ryeol

AU - Kim, Hyunwook

AU - Lee, Hajeong

AU - Lee, Jung Pyo

AU - Lim, Chun Soo

AU - Kim, Kyoung Hoon

AU - Joo, Kwon Wook

AU - Kim, Yon Su

AU - Kim, Dong Ki

AU - Do, J. Y.

AU - Song, S. H.

AU - Kim, S. E.

AU - Kim, S. H.

AU - Kim, Y. H.

AU - Lee, J. S.

AU - Jin, H. J.

AU - Lim, C. S.

AU - Lee, J. P.

AU - Chang, J. H.

AU - Yoo, TaeHyun

AU - Park, J. T.

AU - Oh, H. J.

AU - Park, H. C.

AU - Chang, T. I.

AU - Ryu, D. R.

AU - Oh, D. J.

AU - Chang, Y. S.

AU - Kim, Y. O.

AU - Kim, S. H.

AU - Jin, D. C.

AU - Kim, Y. K.

AU - Kim, H. Y.

AU - Kim, W.

AU - Lee, K. W.

AU - Lee, C. S.

PY - 2015/5/18

Y1 - 2015/5/18

N2 - Background: Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in incident hemodialysis patients (mCCI-IHD), thereby improving risk stratification for mortality. Methods: Data on 24,738 Koreans who received their first hemodialysis treatment between 2005 and 2008 were obtained from the Korean Health Insurance dataset. The mCCI-IHD score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazards model. The modified index was validated in an independent nationwide prospective cohort (n=1,100). Results: The Cox proportional hazards model revealed that all comorbidities in the CCI except ulcers significantly predicted mortality. Thus, the mCCI-IHD included 14 comorbidities with reassigned severity weights. In the validation cohort, both the CCI and the mCCI-IHD were correlated with mortality. However, the mCCI-IHD showed modest but significant increases in c statistics compared with the CCI at 6 months and 1 year. The analyses using continuous net reclassification improvement revealed that the mCCI-IHD improved net mortality risk reclassification by 24.6% (95% CI, 2.5-46.7; P=0.03), 26.2% (95% CI, 1.0-51.4; P=0.04) and 42.8% (95% CI, 4.9-80.8; P=0.03) with respect to the CCI at 6 months and 1 and 2 years, respectively. Conclusions: The mCCI-IHD facilitates better risk stratification for mortality in incident hemodialysis patients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies.

AB - Background: Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in incident hemodialysis patients (mCCI-IHD), thereby improving risk stratification for mortality. Methods: Data on 24,738 Koreans who received their first hemodialysis treatment between 2005 and 2008 were obtained from the Korean Health Insurance dataset. The mCCI-IHD score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazards model. The modified index was validated in an independent nationwide prospective cohort (n=1,100). Results: The Cox proportional hazards model revealed that all comorbidities in the CCI except ulcers significantly predicted mortality. Thus, the mCCI-IHD included 14 comorbidities with reassigned severity weights. In the validation cohort, both the CCI and the mCCI-IHD were correlated with mortality. However, the mCCI-IHD showed modest but significant increases in c statistics compared with the CCI at 6 months and 1 year. The analyses using continuous net reclassification improvement revealed that the mCCI-IHD improved net mortality risk reclassification by 24.6% (95% CI, 2.5-46.7; P=0.03), 26.2% (95% CI, 1.0-51.4; P=0.04) and 42.8% (95% CI, 4.9-80.8; P=0.03) with respect to the CCI at 6 months and 1 and 2 years, respectively. Conclusions: The mCCI-IHD facilitates better risk stratification for mortality in incident hemodialysis patients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies.

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DO - 10.1371/journal.pone.0127240

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Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators. Recalibration and validation of the Charlson comorbidity index in Korean incident hemodialysis patients. PloS one. 2015 May 18;10(5). e0127240. https://doi.org/10.1371/journal.pone.0127240