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A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink

PURPOSE: The CirCom score has been developed from Danish data as a specific measure of comorbidity for cirrhosis to predict all-cause mortality. We compared its performance with the Charlson Comorbidity Index (CCI) in an English cirrhosis population. PATIENTS AND METHODS: We used comorbidity scores...

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Autores principales: Crooks, Colin J, West, Joe, Jepsen, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774468/
https://www.ncbi.nlm.nih.gov/pubmed/29391833
http://dx.doi.org/10.2147/CLEP.S147535
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author Crooks, Colin J
West, Joe
Jepsen, Peter
author_facet Crooks, Colin J
West, Joe
Jepsen, Peter
author_sort Crooks, Colin J
collection PubMed
description PURPOSE: The CirCom score has been developed from Danish data as a specific measure of comorbidity for cirrhosis to predict all-cause mortality. We compared its performance with the Charlson Comorbidity Index (CCI) in an English cirrhosis population. PATIENTS AND METHODS: We used comorbidity scores in a survival model to predict mortality in a cirrhosis cohort in the Clinical Practice Research Datalink. The discrimination of each score was compared by age, gender, socioeconomic status, cirrhosis etiology, cirrhosis stage, and year after cirrhosis diagnosis. We also measured their ability to predict liver-related versus non-liver-related death. RESULTS: There was a small improvement in the C statistic from the model using the CirCom score (C=0.63) compared to the CCI (C=0.62), and there was an overall improvement in the net reclassification index of 1.5%. The improvement was more notable in younger patients, those with an alcohol etiology, and those with compensated cirrhosis. Both scores performed better (C statistic >0.7) for non-liver-related deaths than liver-related deaths (C statistic <0.6), as comorbidity was only weakly predictive of liver-related death. CONCLUSION: The CirCom score provided a small improvement in performance over the CCI in the prediction of all-cause and non-liver mortality, but not liver-related mortality. Therefore, it is important to include a measure of comorbidity in studies of cirrhosis survival, alongside a measure of cirrhosis severity.
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spelling pubmed-57744682018-02-01 A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink Crooks, Colin J West, Joe Jepsen, Peter Clin Epidemiol Original Research PURPOSE: The CirCom score has been developed from Danish data as a specific measure of comorbidity for cirrhosis to predict all-cause mortality. We compared its performance with the Charlson Comorbidity Index (CCI) in an English cirrhosis population. PATIENTS AND METHODS: We used comorbidity scores in a survival model to predict mortality in a cirrhosis cohort in the Clinical Practice Research Datalink. The discrimination of each score was compared by age, gender, socioeconomic status, cirrhosis etiology, cirrhosis stage, and year after cirrhosis diagnosis. We also measured their ability to predict liver-related versus non-liver-related death. RESULTS: There was a small improvement in the C statistic from the model using the CirCom score (C=0.63) compared to the CCI (C=0.62), and there was an overall improvement in the net reclassification index of 1.5%. The improvement was more notable in younger patients, those with an alcohol etiology, and those with compensated cirrhosis. Both scores performed better (C statistic >0.7) for non-liver-related deaths than liver-related deaths (C statistic <0.6), as comorbidity was only weakly predictive of liver-related death. CONCLUSION: The CirCom score provided a small improvement in performance over the CCI in the prediction of all-cause and non-liver mortality, but not liver-related mortality. Therefore, it is important to include a measure of comorbidity in studies of cirrhosis survival, alongside a measure of cirrhosis severity. Dove Medical Press 2018-01-15 /pmc/articles/PMC5774468/ /pubmed/29391833 http://dx.doi.org/10.2147/CLEP.S147535 Text en © 2018 Crooks et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Crooks, Colin J
West, Joe
Jepsen, Peter
A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink
title A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink
title_full A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink
title_fullStr A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink
title_full_unstemmed A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink
title_short A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink
title_sort validation study of the circom comorbidity score in an english cirrhosis population using the clinical practice research datalink
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774468/
https://www.ncbi.nlm.nih.gov/pubmed/29391833
http://dx.doi.org/10.2147/CLEP.S147535
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