The Use Of Charlson Comorbidities Index To Evaluate The Impact Of Underlying Diseases On Prognosis Of Septic Patients

Objective: To investigated the efficiency of the comorbidities by the Charlson comorbidities index(CCI) in predicting the risk of death in septic patients, in order to offer a rapid and reliable tool for clinical assessment.Methods: This study retrospectively analyzed patients admitted to the Department of emergency medicine Tianjin Medical University General Hospital, with a discharge diagnosis of sepsis from December 2012 to July 2014. We collected the general information of patients, including gender, age, history of disease, prognosis of 28 d, hospitalization days. According to the prognosis of 28 d, patients were divided into survival group and death group..We collected clinical variables of all Patients according to the APACHEâ…¡,SOFA and CCI score tables, and calculated respectively. We used SPSS 22 and Med Cal package for data processing. Based on a single faetor logistic regression analysis to define the risk faetors, we performed the multinomial logistic regression analysis and found independent risk faetors which had important effect on clinical. We also used receiver operating characteristic curve(ROC) method to evaluate the performance of each score in predicting prognosis in the patients with sepsis.Results: A total of 204 patients were enrolled in this study. Single factor analysis showed that age, APACHEâ…¡score, CCI score,infection, moderate / severe kidney disease and moderate / severe liver disease had effection in prognosis of septic patients. Increasing CCI was associated with increased mortality. Mean CCI differed significantly between survivors and nonsurvivors(P<0.001), and the univariate logistic regression revealed that risk of death depends significantly of APACHEâ…¡[OR=1.185,95% CI(1.112,1.263),p<0.001],CCI[OR=1.281,95% CI(1.067,1.538),p=0.008].The area under the ROC curve in predicting mortality was 0.816(0.758,0.874) for APACHEâ…¡score, 0.763(0.696,0.829) for SOFA score and 0.708(0.635,0.782) for the CCI. There was a significant difference between the area of CCI score and APACHEâ…¡ score(Z=2.269, P<0.05), and no significant difference between the area of CCI score and SOFA score(Z=1.095, P>0.05). The predictive efficacy of the CCI score was slightly less than the APACHEâ…¡score, and was comparable with the SOFA score.Conclusion: The CCI score was the independent prognostic factors of patients with sepsis,and the CCI scoring system can be used to evaluate the 28 d prognosis of septic patients well.