Journal of the Intensive Care Society 2018, Vol. 19(2) Supplement 1–162, Abstract EP.060
- In a study of 64 patients aged over 50 years admitted for more than 24 hours to ICU in a DGH (Warrington and Halton Foundation Trust, Warrington, UK), Apache II score and Charlson Co-Morbidity Index appear to be predictive of survival
As populations age and emerging treatments become more effective, decisions on the admission of patients who would previously have been unlikely candidates for ICU are becoming increasingly open to scrutiny.
The Charlson Co-Morbidity Index (CCI) was developed to predict 1-year mortality among medical patients. The scale assigns weighted scores to 17 co-morbidities ranging from diabetes to metastases.
Previous studies have compared the CCI with other scoring systems to predict short and long-term mortality following ICU admission. Quach et al2 in 2009 showed that the CCI doesn’t perform as well as the APACHE II in predicting hospital mortality. However Christensen et al3 in 2011 showed that the CCI performed as well as Simplified Acute Physiology Score (SAPS) and APACHE in predicting in-hospital, 30-day and 1-year mortality.
We aimed to look at whether the CCI was predictive of hospital mortality and therefore whether this tool is useful when making admission decisions.
Method: We collected data on consecutive patients over 50 years old admitted for greater than 24 hours to ICU in a District General Hospital between November 2015 and February 2016. ICNARC, APACHE II and CCI were calculated on admission as well as other baseline characteristics. The primary outcome measured was in-hospital mortality.
Results: Data was collected for 64 patients, 37 patients were male, 27 female. The mean age of all patients was 70.0 years. For each of the scoring systems, the mean value was calculated for those who survived and those who died. The means were then compared with a t-test and a P-value calculated. Neither ICNARC score, the number of regular medications taken on admission nor the patient’s age predict in- hospital survival in this group of patients. However, the Apache II score and CCI appear to be predictive of this outcome.
Conclusion: This is a small study of patients admitted to ICU in a DGH. Apache II score and CCI appear to be predictive of survival among patients aged 50 and over. Further work and a larger sample are necessary to confirm these findings, but results suggest that the CCI may be a useful prognostic indicator.
