The value of the Charlson Co-morbidity Index in aneurysmal subarachnoid haemorrhage

Acta Neurochir (Wien). 2014 Sep;156(9):1663-7. doi: 10.1007/s00701-014-2160-3. Epub 2014 Jun 28.


Background: Several studies have included different co-morbid conditions in prediction models for stroke patients. For subarachnoid haemorrhage (SAH), it is not known whether the Charlson Co-morbidity Index (CCI) is associated with outcome. We evaluated if this index was associated with outcome in patients with ruptured intracerebral aneurysms.

Methods: The data of all consecutive aneurysmal SAH (aSAH) patients treated at the Radboudumc, Nijmegen, The Netherlands and entered in the database were retrospectively analysed. Clinical condition at admission was recorded using the WFNS (World Federation of Neurological Surgeons Grading System) grade was collected, as were the age and treatment modality. The burden of co-morbidity was retrospectively registered using the CCI. Outcome was dichotomised on the modified Rankin Scale (mRS; 0-2, favourable outcome; 3-6, unfavourable outcome). A binary logistic regression analysis was performed.

Results: Between 6th May 2008 and 31st July 2013, 457 patients were admitted because of non-traumatic SAH (aSAH). Seventy-seven (16.8 %) patients had no aneurysm. Of the 380 patients with aSAH, information on co-morbid conditions was available for 371 patients. Thirty-six of those 371 had no treatment because of: bad clinical condition in 34 (9.2 %), a non-treatable dissecting aneurysm in 1 (0.3 %) and the explicit wishes of another. Co-morbidity was present in 113 (31.5 %) patients. Binary logistic regression analysis revealed no added value of using the CCI in predicting the outcome (p = 0.91).

Conclusions: This study reports that the CCI is not associated with the outcome classified on the mRS at 6 months in patients after aSAH. The CCI has no added value in case-mix correction.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aneurysm, Ruptured / diagnosis*
  • Aneurysm, Ruptured / epidemiology
  • Aneurysm, Ruptured / therapy*
  • Comorbidity
  • Female
  • Humans
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / epidemiology*
  • Intracranial Aneurysm / therapy*
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Prognosis
  • Retrospective Studies
  • Subarachnoid Hemorrhage / diagnosis
  • Subarachnoid Hemorrhage / epidemiology*
  • Subarachnoid Hemorrhage / therapy*
  • Treatment Outcome