Comparison of Three Comorbidity Measures for Predicting In-Hospital Death through a Clinical Administrative Nacional Database.

BackgroundVarious authors have validated scales to measure comorbidity. However, the prognosis capacity variation according to the comorbidity measurement index used needs to be determined in order to identify which is the best predictor.AimsTo quantify the differences between the Charlson (CCI), Elixhauser (ECI) and van Walraven (WCI) comorbidity indices as prognostic factors for in-hospital mortality and to identify the best comorbidity measure predictor.MethodsA retrospective observational study that included all hospitalizations of patients over 18 years of age, discharged between 2017 and 2021 in the hospital, using the Minimum Basic Data Set (MBDS). We calculated CCI, ECI, WCI according to ICD-10 coding algorithms. The correlation and concordance between the three indices were evaluated by Spearman's rho and Intraclass Correlation Coefficient (ICC), respectively. The logistic regression model for each index was built for predicting in-hospital mortality. Finally, we used the receiver operating characteristic (ROC) curve for comparing the performance of each index in predicting in-hospital mortality, and the Delong method was employed to test the statistical significance of differences.ResultsWe studied 79,425 admission episodes. The 54.29% were men. The median age was 72 years (interquartile range [IQR]: 56-80) and in-hospital mortality rate was 4.47%. The median of ECI was = 2 (IQR: 1-4), ICW was 4 (IQR: 0-12) and ICC was 1 (IQR: 0-3). The correlation was moderate: ECI vs. WCI rho = 0.645, p p p A) = 0.675 (CI 95% 0.665-0.684) p A = 0.797 (CI 95% 0.780-0.812), p A = 0.731 (CI 95% 0.667-0.779), p p > |z| p > |z| p > |z| p ConclusionComorbidity plays an important role as a predictor of in-hospital mortality, with differences depending on the measurement scale used, the van Walraven comorbidity index being the best predictor of in-hospital mortality.