Syeeda S Farruque

models@cambiocds.com

© Cambio Healthcare Systems

The CCI is a good prognostic tool for end stage renal disease (ESRD) patients based in age, serum albumin and upto 19 other comorbid conditions to give an estimate of the 1 and 2 year survival rates. It is an easier to use tool in non-research settings.

The CCI score originally only contained the aggregate score of the 19 comorbid conditions and did not account for age or serum albumin level. This version includes these factors as they show an independent effect on 1 and 2-year survival rates in patients going through dialysis and ESRD. The core score ranges from 0 to 37 and age adds a score of 1 for each decade > 40 years of age for which an age of 120 yrs. (to account for outliers) produces a maximum possible score of 45. The factors in the core score are weighted differently according to how much of a contribution they have to the survival rates. There are 10 comorbid conditions scored with 1, 6 scored with 2, 1 scored with 3 and 2 conditions scored with 6. The serum albumin level is corrected per the lower limit of albumin (LLA) if the value is less than 3.5 g/dl using the equation to get the serum albumin factor: 3.5/LLA. The serum albumin factor is then used to categorise the CMI results [grouped into 2-3, 4-5, 6-7 and >8 scores] to generate the 1 and 2-year survival probability rates [<=3.5g/dl and >3.5g/dl] but does not affect the CCI core score itself. More information on deriving the probability score is shown on (1) CCI score categorisation can be done using the CCI (age-adjusted) score on its own, or with serum albumin levels. 1 and 2 year probability of survival using the CCI score alone: Low (Score ≤ 3) Medium (Score 4-5) High (Score 6-7) Very High (Score ≥ 8) 1 yr 0.98 0.89 0.79 0.64 2 yr 0.95 0.80 0.70 0.35 The serum albumin factor, categorises the CMI results [grouped into ≤3, 4-5, 6-7 and >8 scores] to generate the 1 and 2-year survival probability rates [≤3.5g/dl and >3.5g/dl]. 1 and 2 year probability of survival using serum albumin >3.5g/dl to categorize the score: Low (Score ≤ 3) Medium (Score 4-5) High (Score 6-7) Very High (Score ≥ 8) 1 yr 0.93 0.89 0.84 0.75 2 yr 0.89 0.75 0.67 0.52 1 and 2 year probability of survival using serum albumin ≤3.5g/dl to categorize the score: Low (Score ≤ 3) Medium (Score 4-5) High (Score 6-7) Very High (Score ≥ 8) 1 yr 0.91 0.73 0.69 0.52 2 yr 0.87 0.61 0.49 0.30

Survival estimates should only assist in cases of encouraging informed consent on the issue of starting or ending dialysis

Ref. 1: Touch calc - http://touchcalc.com/calculators/cci_js#t2_probability Ref. 2: Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML: A Simple Comorbidity Scale Predicts Clinical Outcomes and Costs in Dialysis Patients. The American Journal of Medicine 108:609-613, 2000 Ref. 3: Charlson ME, Pompei P, Ales KL, MacKenzie CR: A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation. Journal of Chronic Diseases 40:373-383, 1987

OBSERVATION.cci_scoring_system.v1, OBSERVATION.basic_demographic.v1, EVALUATION.cci_scoring_system_assessment.v1