Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 disease
Abstract Background During the COVID-19 pandemic, nursing home (NH) residents faced the highest risk of severe COVID-19 disease and mortality. Due to their frailty status, comorbidity burden can serve as a useful predictive indicator of vulnerability in this frail population. However, the prognostic...
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BMC
2025-01-01
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| Series: | BMC Geriatrics |
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| Online Access: | https://doi.org/10.1186/s12877-025-05721-2 |
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| author | Anum Zahra Maarten van Smeden Petra J. M. Elders Jan Festen Jacobijn Gussekloo Karlijn J. Joling Anouk van Loon Kim Luijken René J. F. Melis Simon P. Mooijaart Karel G. M. Moons Geeske Peeters Harmke A. Polinder-Bos Fenne Wouters Anne de Hond |
| author_facet | Anum Zahra Maarten van Smeden Petra J. M. Elders Jan Festen Jacobijn Gussekloo Karlijn J. Joling Anouk van Loon Kim Luijken René J. F. Melis Simon P. Mooijaart Karel G. M. Moons Geeske Peeters Harmke A. Polinder-Bos Fenne Wouters Anne de Hond |
| author_sort | Anum Zahra |
| collection | DOAJ |
| description | Abstract Background During the COVID-19 pandemic, nursing home (NH) residents faced the highest risk of severe COVID-19 disease and mortality. Due to their frailty status, comorbidity burden can serve as a useful predictive indicator of vulnerability in this frail population. However, the prognostic value of these cumulative comorbidity scores like the Charlson comorbidity index (CCI) remained unclear in this population. We evaluated the incremental predictive value of the CCI for predicting 28-day mortality in NH residents with COVID-19, compared to prediction using age and sex only. Methods We included older individuals of ≥ 70 years of age in a large retrospective observational cohort across NHs in the Netherlands. Individuals with PCR-confirmed COVID-19 diagnosis from 1 March 2020 to 31 December 2021 were included. The CCI score was computed by searching for the comorbidities recorded in the electronic patient records. All-cause mortality within 28 days was predicted using logistic regression based on age and sex only (base model) and by adding the CCI to the base model (CCI model). The predictive performance of the base model and the CCI model were compared visually by the distribution of predicted risks and area under the receiver operator characteristic curve (AUROC), scaled Brier score, and calibration slope. Results A total of 4318 older NH residents were included in this study with a median age of 88 years [IQR: 83–93] and a median CCI score of 6 [IQR: 5–7]. 1357 (31%) residents died within 28 days after COVID-19 diagnosis. The base model, with age and sex as predictors, had an AUROC of 0.61 (CI: 0.60 to 0.63), a scaled brier score of 0.03 (CI: 0.02 to 0.04), and a calibration slope of 0.97 (CI: 0.83 to 1.13). The addition of CCI did not improve these predictive performance measures. Conclusion The addition of the CCI as a vulnerability indicator did not improve short-term mortality prediction in NH residents. Similar (high) age and number of comorbidities in the NH population could reduce the effectiveness of these predictors, emphasizing the need for other population-specific predictors that can be utilized in the frail NH residents. Graphical Abstract |
| format | Article |
| id | doaj-art-0157a01171c24adfb172f6961b21fb00 |
| institution | Kabale University |
| issn | 1471-2318 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Geriatrics |
| spelling | doaj-art-0157a01171c24adfb172f6961b21fb002025-02-02T12:41:41ZengBMCBMC Geriatrics1471-23182025-01-012511910.1186/s12877-025-05721-2Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 diseaseAnum Zahra0Maarten van Smeden1Petra J. M. Elders2Jan Festen3Jacobijn Gussekloo4Karlijn J. Joling5Anouk van Loon6Kim Luijken7René J. F. Melis8Simon P. Mooijaart9Karel G. M. Moons10Geeske Peeters11Harmke A. Polinder-Bos12Fenne Wouters13Anne de Hond14Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityDepartment of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical CentreKBO-PCOBDepartment of Internal Medicine, Section of Geriatrics and Gerontology, Leiden University Medical CenterDepartment of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit AmsterdamDepartment of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit AmsterdamJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityAging & Later Life, Amsterdam Public Health Research InstituteDepartment of Internal Medicine, Section of Geriatrics and Gerontology, Leiden University Medical CenterJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityDepartment of Geriatric Medicine, Radboud University Medical CenterDivision of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center RotterdamDepartment of Medicine for Older People, Amsterdam UMC, Location Vrije Universiteit AmsterdamJulius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht UniversityAbstract Background During the COVID-19 pandemic, nursing home (NH) residents faced the highest risk of severe COVID-19 disease and mortality. Due to their frailty status, comorbidity burden can serve as a useful predictive indicator of vulnerability in this frail population. However, the prognostic value of these cumulative comorbidity scores like the Charlson comorbidity index (CCI) remained unclear in this population. We evaluated the incremental predictive value of the CCI for predicting 28-day mortality in NH residents with COVID-19, compared to prediction using age and sex only. Methods We included older individuals of ≥ 70 years of age in a large retrospective observational cohort across NHs in the Netherlands. Individuals with PCR-confirmed COVID-19 diagnosis from 1 March 2020 to 31 December 2021 were included. The CCI score was computed by searching for the comorbidities recorded in the electronic patient records. All-cause mortality within 28 days was predicted using logistic regression based on age and sex only (base model) and by adding the CCI to the base model (CCI model). The predictive performance of the base model and the CCI model were compared visually by the distribution of predicted risks and area under the receiver operator characteristic curve (AUROC), scaled Brier score, and calibration slope. Results A total of 4318 older NH residents were included in this study with a median age of 88 years [IQR: 83–93] and a median CCI score of 6 [IQR: 5–7]. 1357 (31%) residents died within 28 days after COVID-19 diagnosis. The base model, with age and sex as predictors, had an AUROC of 0.61 (CI: 0.60 to 0.63), a scaled brier score of 0.03 (CI: 0.02 to 0.04), and a calibration slope of 0.97 (CI: 0.83 to 1.13). The addition of CCI did not improve these predictive performance measures. Conclusion The addition of the CCI as a vulnerability indicator did not improve short-term mortality prediction in NH residents. Similar (high) age and number of comorbidities in the NH population could reduce the effectiveness of these predictors, emphasizing the need for other population-specific predictors that can be utilized in the frail NH residents. Graphical Abstracthttps://doi.org/10.1186/s12877-025-05721-2Charlson comorbidity indexFrailtyVulnerabilityCOVID‐19Older peoplePrognosis research |
| spellingShingle | Anum Zahra Maarten van Smeden Petra J. M. Elders Jan Festen Jacobijn Gussekloo Karlijn J. Joling Anouk van Loon Kim Luijken René J. F. Melis Simon P. Mooijaart Karel G. M. Moons Geeske Peeters Harmke A. Polinder-Bos Fenne Wouters Anne de Hond Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 disease BMC Geriatrics Charlson comorbidity index Frailty Vulnerability COVID‐19 Older people Prognosis research |
| title | Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 disease |
| title_full | Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 disease |
| title_fullStr | Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 disease |
| title_full_unstemmed | Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 disease |
| title_short | Charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with COVID-19 disease |
| title_sort | charlson comorbidity index has no incremental value for mortality risk prediction in nursing home residents with covid 19 disease |
| topic | Charlson comorbidity index Frailty Vulnerability COVID‐19 Older people Prognosis research |
| url | https://doi.org/10.1186/s12877-025-05721-2 |
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