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Elixhauser outperformed Charlson comorbidity index in prognostic value after ACS: insights from a national registry.

Mamas

Authors



Abstract

OBJECTIVE: To compare the performance of risk adjustment models using the Elixhauser and Charlson comorbidity scores in predicting in-hospital outcomes of ACS patients from a nationwide administrative database. STUDY DESIGN AND SETTING: All hospitalisations for ACS in the United States between 2004 and 2014 (n=7,201,900) were retrospectively analysed. We used ECS and CCI score based on ICD-9 codes to define comorbidity variables. Logistic regression models were fitted to three in-hospital outcomes, including mortality, Major Acute Cardiovascular & Cerebrovascular Events (MACCE) and bleeding. The prognostic values of ECS and CCI after adjusting for known confounders, were compared using the C-statistic, Akaike information criterion (AIC) and Bayesian information criterion (BIC). RESULTS: The statistical performance of models predicting all in-hospital outcomes demonstrated that the ECS had superior prognostic value compared to the CCI, with higher C-statistics and lower AIC and BIC values associated with the former. CONCLUSION: This is the first study that compared the prognostic value of the ECS and CCI scores in predicting multiple ACS outcomes, based on their scoring systems. Better discrimination and goodness of fit was achieved with the Elixhauser method across all in-hospital outcomes studied.

Acceptance Date Aug 20, 2021
Publication Date Aug 27, 2021
Journal Journal of Clinical Epidemiology
Print ISSN 0895-4356
Publisher Elsevier
Pages 26-35
DOI https://doi.org/10.1016/j.jclinepi.2021.08.025
Keywords acute coronary syndrome; comorbidity index; Charlson Score; Elixhauser score; model performance; model comparison
Publisher URL https://www.jclinepi.com/article/S0895-4356(21)00270-5/fulltext

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