JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B 2014 Vol.15 No.1 P.58-66

Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy*

Author(s): You-qun Huang, Rong Gou, Yong-shu Diao, Qing-hua Yin, Wen-xing Fan, Ya-ping Liang, Yi Chen, Min Wu, Li Zang, Ling Li, Jing Zang, Lu Cheng, Ping Fu, Fang Liu
Affiliation(s): . Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, China
Corresponding email(s): liufangfh@163.com
Key Words: Diabetic nephropathy (DN), Charlson comorbidity index (CCI), Mortality

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You-qun Huang, Rong Gou, Yong-shu Diao, Qing-hua Yin, Wen-xing Fan, Ya-ping Liang, Yi Chen, Min Wu, Li Zang, Ling Li, Jing Zang, Lu Cheng, Ping Fu, Fang Liu. Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy[J]. Journal of Zhejiang University Science B, 2014, 15(1): 58-66.

@article{title="Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy",
author="You-qun Huang, Rong Gou, Yong-shu Diao, Qing-hua Yin, Wen-xing Fan, Ya-ping Liang, Yi Chen, Min Wu, Li Zang, Ling Li, Jing Zang, Lu Cheng, Ping Fu, Fang Liu",
journal="Journal of Zhejiang University Science B",
volume="15",
number="1",
pages="58-66",
year="2014",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1300109"
}

%0 Journal Article
%T Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy
%A You-qun Huang
%A Rong Gou
%A Yong-shu Diao
%A Qing-hua Yin
%A Wen-xing Fan
%A Ya-ping Liang
%A Yi Chen
%A Min Wu
%A Li Zang
%A Ling Li
%A Jing Zang
%A Lu Cheng
%A Ping Fu
%A Fang Liu
%J Journal of Zhejiang University SCIENCE B
%V 15
%N 1
%P 58-66
%@ 1673-1581
%D 2014
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1300109

TY - JOUR
T1 - Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy
A1 - You-qun Huang
A1 - Rong Gou
A1 - Yong-shu Diao
A1 - Qing-hua Yin
A1 - Wen-xing Fan
A1 - Ya-ping Liang
A1 - Yi Chen
A1 - Min Wu
A1 - Li Zang
A1 - Ling Li
A1 - Jing Zang
A1 - Lu Cheng
A1 - Ping Fu
A1 - Fang Liu
J0 - Journal of Zhejiang University Science B
VL - 15
IS - 1
SP - 58
EP - 66
%@ 1673-1581
Y1 - 2014
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1300109

Abstract
Chinese Summary
Academic Network
Reviewer Comment

Abstract: Our intent is to examine the predictive role of charlson comorbidity index (CCI) on mortality of patients with type 2 diabetic nephropathy (DN). Based on the CCI score, the severity of comorbidity was categorized into three grades: mild, with CCI scores of 1–2; moderate, with CCI scores of 3–4; and severe, with CCI scores ≥5. Factors influencing mortality and differences between groups stratified by CCI were determined by logistical regression analysis and one-way analysis of variance (ANOVA). The impact of CCI on mortality was assessed by the Kaplan-Meier analysis. A total of 533 patients with type 2 DN were enrolled in this study, all of them had comorbidity (CCI score >1), and 44.7% (238/533) died. The mortality increased with CCI scores: 21.0% (50/238) patients with CCI scores of 1–2, 56.7% (135/238) patients with CCI scores of 3–4, and 22.3% (53/238) patients with CCI scores ≥5. Logistical regression analysis showed that CCI scores, hemoglobin, and serum albumin were the potential predictors of mortality (P<0.05). One-way ANOVA analysis showed that DN patients with higher CCI scores had lower levels of hemoglobulin, higher levels of serum creatinine, and higher mortality rates than those with lower CCI scores. The Kaplan-Meier curves showed that survival time decreased when the CCI scores and mortality rates went up. In conclusion, CCI provides a simple, readily applicable, and valid method for classifying comorbidities and predicting the mortality of type 2 DN. An increased awareness of the potential comorbidities in type 2 DN patients may provide insights into this complicated disease and improve the outcomes by identifying and treating patients earlier and more effectively.

Charlson合并症指数对2型糖尿病肾病死亡率预测作用的研究

研究目的：探讨Charlson合并症指数（CCI）对2型糖尿病肾病死亡率的预测作用。
研究手段：建立2型糖尿病肾病研究队列，根据CCI评分将患者合并症的严重程度分为三度：轻度（CCI 1–2分）、中度（CCI 3–4分）、重度（CCI ≥5分）。将影响死亡率的因素及按CCI分层后的组间差异指标进行Logistic回归分析及方差分析（ANOVA）。Kaplan-Meier生存曲线分析CCI指数对生存时间及死亡率的影响。
重要结论：533例2型糖尿病肾病患者纳入研究。所有患者的CCI评分均大于1，44.7%（238/533）的患者死亡。患者的死亡率随CCI评分增加而增加，CCI 1–2分患者的死亡率为21.0%（50/238），CCI 3–4分患者的死亡率为56.7%（135/238），CCI ≥5分患者的死亡率为22.3%（53/238）。Logistic回归分析显示CCI评分、血红蛋白和血浆白蛋白水平是患者死亡率的预测因子（P<0.05）。方差分析结果显示，与CCI评分相对较低的患者相比，CCI评分越高的患者其血红蛋白水平较低，而血清肌酐较高，死亡率也更高。Kaplan-Meier生存曲线显示CCI评分越高的患者生存时间越短。CCI评分是一种简单易行且实用的评估疾病合并症的方法，可用于预测2型糖尿病肾病患者的死亡率。关注2型糖尿病肾病患者的合并症将有利于早期、有效治疗及改善预后。

关键词：糖尿病肾病；Charlson合并症指数；死亡率

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References

[1] Charlson, M.E., Pompei, P., Ales, K.L., 1987. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 40(5):373-383.

[2] Debella, Y.T., Giduma, H.D., Light, R.P., 2011. Chronic kidney disease as a coronary disease equivalent—a comparison with diabetes over a decade. Clin J Am Soc Nephrol, 6(6):1385-1392.

[3] de Groot, V., Beckerman, H., Lankhorst, G.J., 2003. How to measure comorbidity: a critical review of available methods. J Clin Epidemiol, 56(3):221-229.

[4] Feinstein, A.R., 1970. The pre-therapeutic classification of comorbidity in chronic disease. J Chronic Dis, 23(7):455-468.

[5] Foley, R.N., Parfrey, P.S., Harnett, J.D., 1996. Hypoalbuminemia, cardiac morbidity, and mortality in end-stage renal disease. J Am Soc Nephrol, 7(5):728-736.

[6] Gerstein, H.C., Pogue, J., Mann, J.F., 2005. The relationship between dysglycaemia and cardiovascular and renal risk in diabetic and non-diabetic participants in the HOPE study: a prospective epidemiological analysis. Diabetologia, 48(9):1749-1755.

[7] Guralnik, J.M., 1996. Assessing the impact of comorbidity in the older population. Ann Epidemiol, 6(5):376-380.

[8] Hall, S.F., 2006. A user’s guide to selecting a comorbidity index for clinical research. J Clin Epidemiol, 59(8):849-855.

[9] Keane, W.F., Brenner, B.M., de Zeeuw, D., 2003. The risk of developing end-stage renal disease in patients with type 2 diabetes and nephropathy: the RENAAL study. Kidney Int, 63(4):1499-1507.

[10] Kieszak, S.M., Flanders, W.D., Kosinski, A.S., 1999. A comparison of the Charlson comorbidity index derived from medical record data and administrative billing data. J Clin Epidemiol, 52(2):137-142.

[11] Lhotta, K., Zoebl, M., Mayer, G., 2003. Late referral defined by renal function: association with morbidity and mortality. J Nephrol, 16(6):855-861.

[12] McEwen, L.N., Kim, C., Karter, A.J., 2007. Risk factors for mortality among patients with diabetes: the translating research into action for diabetes (TRIAD) study. Diab Care, 30(7):1736-1741.

[13] McFarlane, S.I., Salifu, M.O., Makaryus, J., 2006. Anemia and cardiovascular disease in diabetic nephropathy. Curr Diab Rep, 6(3):213-218.

[14] Mnatzaganian, G., Ryan, P., Norman, P.E., 2012. Accuracy of hospital morbidity data and the performance of comorbidity scores as predictors of mortality. J Clin Epidemiol, 65(1):107-115.

[15] National Kidney Foundation, 2002. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis, 39(2S):S1-S266.

[16] Ritz, E., 2005. Managing anaemia and diabetes: a future challenge for nephrologists. Nephrol Dial Transplant, 20(Suppl. 6):S21-S25.

[17] Ritz, E., Rychlk, I., Locatelli, F., 1999. End-stage renal failure in type 2 diabetes: a medical catastrophe of worldwide dimensions. Am J Kidney Dis, 34(5):795-808.

[18] Rochon, P.A., Katz, J.N., Morrow, L.A., 1996. Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices. Med Care, 34(11):1093-1101.

[19] Sarfati, D., Tan, L., Blakely, T., 2011. Comorbidity among patients with colon cancer in New Zealand. N Z Med J, 124(1338):76-88.

[20] So, W.Y., Kong, A.P., Ma, R.C., 2006. Glomerular filtration rate, cardiorenal end points, and all-cause mortality in type 2 diabetic patients. Diab Care, 29(9):2046-2052.

[21] Suliman, M.E., Qureshi, A.R., Brny, P., 2000. Hyperhomocysteinemia, nutritional status, and cardiovascular disease in hemodialysis patients. Kidney Int, 57(4):1727-1735.

[22] Thomas, M.C., MacIsaac, R.J., Tsalamandris, C., 2003. Unrecognized anemia in patients with diabetes: a cross-sectional survey. Diab Care, 26(4):1164-1169.

[23] Ueda, H., Ishimura, E., Shoji, T., 2003. Factors affecting progression of renal failure in patients with type 2 diabetes. Diab Care, 26(5):1530-1534.

[24] US Renal Data System, 2002. USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases,Bethesda, MD :

[25] van den Akker, M., Buntinx, F., Metsemakers, J.F., 1998. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol, 51(5):367-375.

[26] West, D.W., Satariano, W.A., Ragland, D.R., 1996. Comorbidity and breast cancer survival: a comparison between black and white women. Ann Epidemiol, 6(5):13-19.

[27] Yancik, R., Ershler, W., Satariano, W., 2007. Report of the national institute on aging task force on comorbidity. J Gerontol A Biol Sci Med Sci, 62(3):275-280.

[28] Yang, W., Lu, J., Weng, J., 2010. Prevalence of diabetes among men and women in China. N Engl J Med, 362(12):1090-1101.

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Charlson合并症指数对2型糖尿病肾病死亡率预测作用的研究

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