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The Charlson Comorbidity and Barthel Index predict length of hospital stay, mortality, cardiovascular mortality and rehospitalization in unselected older patients admitted to the emergency department

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Abstract

Background and aims

The Charlson Comorbidity Index (CCI) is the most widely used assessment tool to report the presence of comorbid conditions. The Barthel index (BI) is used to measure performance in activities of daily living. We prospectively investigated the performance of CCI or BI to predict length of hospital stay (LOS), mortality, cardiovascular (CV) mortality and rehospitalization in unselected older patients on admission to the emergency department (ED). We also studied the association of CCI or BI with costs.

Methods

We consecutively enrolled 307 non-surgical patients ≥ 68 years presenting to the ED with a wide range of comorbid conditions. Baseline characteristic, clinical presentation, laboratory data, echocardiographic parameters and hospital costs were compared among patients. All patients were followed up for mortality, CV mortality and rehospitalization within the following 12 months. A multivariate analysis was performed.

Results

Mortality was increased for patients having a higher CCI or BI with a hazard ratio around 1.17–1.26 or 0.75–0.81 (obtained for different models) for one or ten point increase in CCI or BI, respectively. The prognostic impact of a high CCI or BI on CV mortality and rehospitalization was also significant. In a multiple linear regression using the same independent variables, CCI and BI were identified as a predictor of LOS in days. Multiple linear regression analysis did not confirm an association between CCI and costs, but for BI after adjusting for multiple factors.

Conclusion

CCI and BI independently predict LOS, mortality, CV mortality, and rehospitalization in unselected older patients admitted to ED.

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Funding

This study was funded by Forschungskolleg Geriatrie of the Robert-Bosch-Foundation, Stuttgart, Germany (Grant no. 32.5.1141.0036.0).

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Authors and Affiliations

  1. Department of Cardiology, Angiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany

    Anke Bahrmann & Hugo Katus

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Laura Benner

  3. Department of Emergency Medicine, Luzerner Kantonsspital, Lucerne, Switzerland

    Michael Christ

  4. Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany

    Thomas Bertsch

  5. Institute for Biomedicine of Aging, Friedrich-Alexander-University, Kobergerstr. 60, 90408, Nuremberg, Germany

    Cornel C. Sieber & Philipp Bahrmann

Authors
  1. Anke Bahrmann
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  2. Laura Benner
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  3. Michael Christ
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  4. Thomas Bertsch
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  5. Cornel C. Sieber
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  6. Hugo Katus
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  7. Philipp Bahrmann
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Correspondence to Philipp Bahrmann.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All patients or their guardians provided written informed consent.

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Bahrmann, A., Benner, L., Christ, M. et al. The Charlson Comorbidity and Barthel Index predict length of hospital stay, mortality, cardiovascular mortality and rehospitalization in unselected older patients admitted to the emergency department. Aging Clin Exp Res 31, 1233–1242 (2019). https://doi.org/10.1007/s40520-018-1067-x

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  • DOI: https://doi.org/10.1007/s40520-018-1067-x

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