Charlson Comorbidity Index

Interpretation

Survival estimates from Charlson 1987 cohort. Contemporary survival may be higher due to improved management of individual conditions.

Clinical Application

• The raw CCI counts only disease burden. The age-adjusted CCI adds 1 point per decade over age 40 — this is the most clinically and prognostically useful version.
• Preoperative counselling: A CCI ≥ 3 indicates significant comorbidity burden that should be discussed with the patient and documented in the consent process, particularly for elective major surgery.
• Research use: CCI is one of the most widely used case-mix adjustment tools in retrospective surgical and oncology studies. It is readily computable from ICD-coded administrative data.
• Diabetes: Score either uncomplicated (1 pt) or with end-organ damage (2 pts) — not both. Choose the higher weight if complications are present.
• Liver disease: Mild liver disease (Child A cirrhosis, chronic hepatitis) = 1 pt. Moderate/severe (Child B/C, portal hypertension, oesophageal varices, liver failure) = 3 pts.
• Note: HIV without AIDS-defining illness does not score points. Presence of an AIDS-defining condition (CD4 <200 or opportunistic infection) scores 6 pts.

References

1. Charlson ME, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383.
2. Quan H, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–1139.
3. Charlson M, et al. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–1251.

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