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Objectives: The present study aimed to validate the new international guidelines for IPMN and determine the surgical criteria for patients with IPMN exhibiting high-risk stigmata (HRS). Methods: We enrolled 115 IPMN patients exhibiting HRS who were diagnosed between 2004 and 2021. Of the 115 patients, 79 underwent surgery (surgical group) and 36 did not undergo surgery (non-surgical group). The overall survival (OS) of each group was compared, and multivariate analysis was performed to identify factors associated with OS. Results: There was no significant difference in the estimated 5-year OS in the surgical and non-surgical groups (67% vs. 74%; p = 0.75). The presence of a solid component (SC) (hazard ratio [HR], 6.92; 95% confidence interval [CI], 3.30–14.5) and a high score of age-adjusted Charlson comorbidity index (ACCI) (≥5) (HR, 2.27; 95% CI, 1.11–4.64) were independent predictors of poor OS. In the presence of an SC, the surgical group had a significantly better OS than the non-surgical group (estimated 5-year OS, 38% vs. 18%; p = 0.031). In the absence of an SC, the prognosis of patients with a high ACCI was significantly poorer than those with a low ACCI in the surgical group (estimated 5-year OS, 59% vs. 93%; p = 0.005). Conclusions: An SC and a high ACCI are important prognostic factors in IPMN patients exhibiting HRS. Thus, patients with an SC should undergo surgical resection. However, conservative management may be the optimal treatment in patients without an SC and with a high ACCI. [ABSTRACT FROM AUTHOR]

Objective: This study aims to compare the efficacy of the Age-adjusted Charlson Comorbidity Index (ACCI) and the Elixhauser-Van Walraven Comorbidity Index (ECI-VW) in predicting mortality risk among patients undergoing heart valve surgery. Methods: Clinical data were extracted from the INSPIRE Database using R language. The Receiver Operating Characteristic (ROC) Curve was employed to assess the predictive accuracy of ACCI and ECI-VW for in-hospital all-cause mortality and post-surgical all-cause mortality at 7 and 28 days. Subgroup analysis was conducted to validate the application efficacy, and the optimal cutoff value was identified. Results: The study included 996 patients, with 931 survivors and 65 cases of in-hospital all-cause mortality. The area under the curve (AUC) for ACCI in predicting in-hospital all-cause mortality was 0.658 (95% CI: 0.584, 0.732), while the AUC for ECI-vw in predicting the same outcome was 0.663 (95% CI: 0.584, 0.741). For predicting all-cause mortality within 7 days post-surgery, the AUC of ACCI was 0.680 (95% CI: 0.04, 0.56), and for ECI-vw, it was 0.532 (95% CI: 0.353, 0.712). Regarding the prediction of all-cause mortality within 28 days after surgery, the AUC for ACCI was 0.724 (95% CI: 0.622, 0.827), and for ECI-vw, it was 0.653 (95% CI: 0.538, 0.69). Patients were categorized into two groups based on the ACCI cutoff value of 3.5, including Group 1 (ACCI < 3.5 points, 823 cases) and Group 2 (ACCI > 3.5 points, 173 cases). The overall survival rate for these two patient groups was calculated using the Kaplan-Meier method, revealing that the 28-day postoperative survival rate for patients in Group 1 was significantly higher than that for patients in Group 2 (P < 0.0001). Conclusions: ACCI demonstrates significant predictive value for in-hospital all-cause mortality within 28 days following cardiac valve disease surgery. Patients presenting with an ACCI greater than 3.5 exhibit an increased risk of mortality within 28 days post-surgery compared to those with an ACCI less than 3.5. This finding suggests that the ACCI can serve as a preliminary tool for assessing the prognosis of patients undergoing this type of surgical intervention. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Aims Methods Results Conclusions Early identification of hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) holds crucial importance in guiding clinical management and reducing mortality. However, existing scoring systems often overlook patient's underlying clinical condition, which significantly impacts prognosis.Use the age‐adjusted Charlson comorbidity index (aCCI) to evaluate the patient's complications to develop a more precise model for predicting transplant‐free mortality in HBV‐ACLF patients.Nine hundred and six patients were included for investigation and were segregated into a training cohort and a temporal validation cohort according to the chronological order of admission in a ratio of 7:3. In the training cohort, univariate analysis, logistic regression analysis and LASSO regression analysis were used to construct a prognostic model and it was subsequently validated in a temporal validation cohort and an external validation cohort.We found total bilirubin, neutrophils, international normalised ratio and aCCI exhibited significant associations with 28‐day transplant‐free mortality and established a novel prognostic model, named aCCI‐HBV‐ACLF. The model demonstrated strong predictive performance, with area under the receiver operating characteristic curve (ROC) values of 0.859 for 28‐day mortality, 0.822 for 90‐day mortality. In the temporal validation cohort, aCCI‐HBV‐ACLF achieved area under the ROC values of 0.869 for 28‐day mortality and 0.850 for 90‐day mortality. In the external validation cohort, aCCI‐HBV‐ACLF had area under the ROC values of 0.868 for 28‐day mortality and 0.888 for 90‐day mortality.This study proposes a new prognostic model, which achieved excellent predictive ability for 28−/90‐day transplant‐free mortality rates among patients with HBV‐ACLF. [ABSTRACT FROM AUTHOR]

Yi-Yun Sheng,1 Qing Zhu,2 Qian-Bin Dai,2 Yu-Jie Gao,2 Yun-Xue Bai,2 Mei-Fang Liu2 1Department of Pathology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of China; 2Department of Clinical Laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of ChinaCorrespondence: Mei-Fang Liu, Department of Clinical Laboratory, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, People’s Republic of China, Tel +86 0791 86319430, Fax +86 0791 88692272, Email mfliu922@163.comPurpose: This study aimed to examine the association between the systemic immune-inflammation index (SII) (ie, neutrophil count × platelet count/lymphocyte count), the age-adjusted Charlson comorbidity index (ACCI), and overall survival (OS) in non-small cell lung cancer (NSCLC) patients undergoing first-line platinum-based chemotherapy (PBC), with a particular emphasis on the role of SII in supporting ACCI.Patients and Methods: This retrospective study enrolled 353 cases treated between July 2013 and November 2020. Mann–Whitney U-test and Kruskal–Wallis test were employed to compare parameters between high and low SII groups. The cut-off values for SII and ACCI were determined using the X-tile software. Prognostic significance was evaluated through the utilization of Kaplan-Meier curves and Cox regression analysis.Results: In a univariate Cox regression analysis, sex, age, TNM, lymph node, therapy, SII, and ACCI were associated with OS. After adjusting for confounders in the multivariate analysis, TNM, SII, and ACCI remained independent prognostic factors for OS. Furthermore, within the ACCI subgroups (ACCI< 5 or ACCI≥ 5), a high SII was significantly associated with an increased risk of death. Patients with both a high ACCI and a high SII had the highest risk of death (p < 0.001), with a loss of approximately ten months of survival during the first three years after treatment.Conclusion: SII was proven to be valuable in predicting OS and, when complemented by ACCI, can help tailor prognostic assessment and treatment strategies in assessing the survival of NSCLC patients with first-line PBC.Keywords: non-small cell lung cancer, platinum-based chemotherapy, systemic immune-inflammation index, age-adjusted Charlson comorbidity index, prognostic, overall survival

Abstract Objective This study aims to compare the efficacy of the Age-adjusted Charlson Comorbidity Index (ACCI) and the Elixhauser-Van Walraven Comorbidity Index (ECI-VW) in predicting mortality risk among patients undergoing heart valve surgery. Methods Clinical data were extracted from the INSPIRE Database using R language. The Receiver Operating Characteristic (ROC) Curve was employed to assess the predictive accuracy of ACCI and ECI-VW for in-hospital all-cause mortality and post-surgical all-cause mortality at 7 and 28 days. Subgroup analysis was conducted to validate the application efficacy, and the optimal cutoff value was identified. Results The study included 996 patients, with 931 survivors and 65 cases of in-hospital all-cause mortality. The area under the curve (AUC) for ACCI in predicting in-hospital all-cause mortality was 0.658 (95% CI: 0.584, 0.732), while the AUC for ECI-vw in predicting the same outcome was 0.663 (95% CI: 0.584, 0.741). For predicting all-cause mortality within 7 days post-surgery, the AUC of ACCI was 0.680 (95% CI: 0.04, 0.56), and for ECI-vw, it was 0.532 (95% CI: 0.353, 0.712). Regarding the prediction of all-cause mortality within 28 days after surgery, the AUC for ACCI was 0.724 (95% CI: 0.622, 0.827), and for ECI-vw, it was 0.653 (95% CI: 0.538, 0.69). Patients were categorized into two groups based on the ACCI cutoff value of 3.5, including Group 1 (ACCI 3.5 points, 173 cases). The overall survival rate for these two patient groups was calculated using the Kaplan-Meier method, revealing that the 28-day postoperative survival rate for patients in Group 1 was significantly higher than that for patients in Group 2 (P

Abstract Background There is growing evidence linking the age-adjusted Charlson comorbidity index (aCCI), an assessment tool for multimorbidity, to fragility fracture and fracture-related postoperative complications. However, the role of multimorbidity in osteoporosis has not yet been thoroughly evaluated. We aimed to investigate the association between aCCI and the risk of osteoporosis in older adults at moderate to high risk of falling. Methods A total of 947 men were included from January 2015 to August 2022 in a hospital in Beijing, China. The aCCI was calculated by counting age and each comorbidity according to their weighted scores, and the participants were stratified into two groups by aCCI: low (aCCI

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Abstract Background Lip squamous cell carcinoma (LSCC) was one of the most common cancer types of head and neck tumors. This study aimed to find more predictors of the prognosis in postoperative LSCC patients. Methods A total of 147 LSCC patients between June 2012 and June 2018 were collected from two tertiary care institutions. There were 21 clinicopathological factors included and analyzed in our study. The univariate and multivariate Cox regression analyses were performed to find the independent prognostic factors for predicting progression-free survival (PFS) and overall survival (OS) in postoperative LSCC patients. The role of adjuvant radiotherapy in various subgroups was displayed by Kaplan–Meier plots. Results The 1-, 3-, and 5-year PFS of postoperative LSCC patients were 88.4%, 70.1%, and 57.8%, respectively. Similarly, the 1-, 3-, and 5-year OS of postoperative LSCC patients were 94.6%, 76.9%, and 69.4%, respectively. The results suggested that postoperative LSCC patients with age at diagnosis ≥ 70 years, grade with moderate or poor differentiate, the American Joint Committee on Cancer (AJCC) stage IV, higher systemic immune-inflammation index (SII), surgical margin

Objectives: The present study aimed to validate the new international guidelines for IPMN and determine the surgical criteria for patients with IPMN exhibiting high-risk stigmata (HRS). Methods: We enrolled 115 IPMN patients exhibiting HRS who were diagnosed between 2004 and 2021. Of the 115 patients, 79 underwent surgery (surgical group) and 36 did not undergo surgery (non-surgical group). The overall survival (OS) of each group was compared, and multivariate analysis was performed to identify factors associated with OS. Results: There was no significant difference in the estimated 5-year OS in the surgical and non-surgical groups (67% vs. 74%; p = 0.75). The presence of a solid component (SC) (hazard ratio [HR], 6.92; 95% confidence interval [CI], 3.30–14.5) and a high score of age-adjusted Charlson comorbidity index (ACCI) (≥5) (HR, 2.27; 95% CI, 1.11–4.64) were independent predictors of poor OS. In the presence of an SC, the surgical group had a significantly better OS than the non-surgical group (estimated 5-year OS, 38% vs. 18%; p = 0.031). In the absence of an SC, the prognosis of patients with a high ACCI was significantly poorer than those with a low ACCI in the surgical group (estimated 5-year OS, 59% vs. 93%; p = 0.005). Conclusions: An SC and a high ACCI are important prognostic factors in IPMN patients exhibiting HRS. Thus, patients with an SC should undergo surgical resection. However, conservative management may be the optimal treatment in patients without an SC and with a high ACCI.

The prognostic role of the Age-Adjusted Charlson Comorbidity Index (ACCI) in hilar cholangiocarcinoma patients undergoing laparoscopic resection is unclear. To evaluate ACCI's effect on overall survival (OS) and recurrence-free survival (RFS), we gathered data from 136 patients who underwent laparoscopic resection for hilar cholangiocarcinoma at Zhengzhou University People's Hospital between 1 June 2018 and 1 June 2022. ACCI scores were categorized into high ACCI (ACCI > 4.0) and low ACCI (ACCI ≤ 4.0) groups. We examined ACCI's association with OS and RFS using Cox regression analyses and developed an ACCI-based nomogram for survival prediction. Our analysis revealed that higher ACCI scores (ACCI > 4.0) (HR = 2.14, 95%CI: 1.37–3.34) were identified as an independent risk factor significantly affecting both OS and RFS in postoperative patients with hilar cholangiocarcinoma (p < 0.05). TNM stage III-IV (HR = 7.42, 95%CI: 3.11–17.68), not undergoing R0 resection (HR = 1.58, 95%CI: 1.01–2.46), hemorrhage quantity > 350 mL (HR = 1.92, 95%CI: 1.24–2.97), and not receiving chemotherapy (HR = 1.89, 95%CI: 1.21–2.95) were also independent risk factors for OS. The ACCI-based nomogram accurately predicted the 1-, 2-, and 3-year OS rates, with Area Under the Curve (AUC) values of 0.818, 0.844, and 0.924, respectively. Calibration curves confirmed the nomogram's accuracy, and decision curve analysis highlighted its superior predictive performance. These findings suggest that a higher ACCI is associated with a worse prognosis in patients undergoing laparoscopic resection for hilar cholangiocarcinoma. The ACCI-based nomogram could aid clinicians in making accurate predictions about patient survival and facilitate individualized treatment planning. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to analyze the treatment outcomes and develop a predictive model of surgical treatment for gastric cancer, taking into account the comorbidity of patients. Material and Methods. The treatment outcomes were studied in 477 (100 %) gastric cancer patients. Patients were stratifed into two groups according to the Age-Adjusted Charlson Comorbidity Index (ACCI) (0–4 points – 311 (65,2 %), more than 4 points – 166 (34,8 %) patients). Two hundred and seventy six patients (57.9 %) underwent distal or total gastrectomy, 178 (37.3 %) total gastrectomy, 19 (4 %) minimally invasive gastrectomy, and 4 (0.8 %) patients underwent extirpation of the gastric stump. The construction of models for the prognosis of surgical treatment was carried out using binary logistic regression, the comparison of models – by analyzing error curves (ROC-analysis). Results. The incidence rate of postoperative complications (grade III-V) according to the Clavien-Dindo classifcation was signifcantly higher in group 2 (9.9 %, 47/477) compared to group 1 (2.1 %, 10/477) (χ2 =64.79, p

Abstract Background Concomitant diseases often occur in cancer patients and are important in decision-making regarding treatments. However, information regarding the prognostic relevance of comorbidities for mortality risk is still limited among Chinese gastric cancer (GC) patients. This study aimed to investigate the association between comorbidities and 3-year mortality risk. Methods This retrospective study enrolled 376 GC patients undergoing radical gastrectomy at the Affiliated Zhongshan Hospital of Dalian University from January 2011 to December 2019. Demographic and clinicopathological information and treatment outcomes were collected. Patients were divided into low-, moderate- and high-risk comorbidity groups based on their Charlson Comorbidity Index (CCI) and age-adjusted CCI (ACCI) scores. Kaplan-Meier survival and Cox regression analyses were used to examine 3-year overall survival (OS) and mortality risk for each group. Results The median follow-up time was 43.5 months, and 40.2% (151/376) of GC patients had died at the last follow-up. There were significant differences in OS rates between ACCI-based comorbidity groups (76.56; 64.51; 54.55%, log-rank P = 0.011) but not between CCI-based comorbidity groups (log-rank P = 0.16). The high-risk comorbidity group based on the ACCI remained a significant prognostic factor for 3-year OS in multivariate analysis, with an increased mortality risk (hazard ratio [HR], 1.99; 95% CI, 1.15–3.44). Subgroup analysis revealed that this pattern only held for male GC patients but not for female patients. Conclusion The present study suggested that high-risk comorbidities were significantly associated with a higher mortality risk, particularly in Chinese male GC patients. Moreover, the ACCI score was an independent prognostic factor of long-term mortality.

Zhe Wang, Ying Zhong, Yidong Zhou, Feng Mao, Xiaohui Zhang, Changjun Wang, Qiang Sun Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of ChinaCorrespondence: Qiang Sun, Email sunqpumch@163.comPurpose: This study aimed to assess the effect of comorbidities on prognosis using the Age-adjusted Charlson Comorbidity Index (ACCI) among the elderly with breast cancer (BC).Methods: This study included 745 patients divided into two groups following the ACCI score (≤ 3 vs > 3). Multivariate logistic regression analysis was conducted for all kinds of outcomes, including BC-specific death (BCSD) and non-breast cancer-specific death (NBCSD). The Kaplan–Meier curves were plotted, and survival analysis was conducted for disease-free survival (DFS), overall survival (OS), BC-specific survival (BCSS), and non-BCSS (NBCSS).Results: A significantly higher NBCSD was found in the high-score (ACCI > 3) group than in the low-score (ACCI < 3) group (p = 0.032). The multivariate logistic regression analysis revealed ACCI score as an independent affecting factor for all-cause death (hazard ratio [HR] = 0.42, 95% confidence interval [CI]: 0.22– 0.83, p = 0.012) and NBCSD (HR = 0.41, 95% CI: 0.20– 0.87, p = 0.020). The Kaplan–Meier curves revealed statistical differences only in NBCSS between the two groups (p = 0.039). Subgroup analysis revealed a worse prognosis in the high-score group for OS and NBCSS among hormone receptor-positive participants and those who without undergoing axillary dissection or receiving chemotherapy (all p < 0.05). Multivariate Cox regression analysis revealed ACCI as an independent prognostic predictor for OS (HR = 2.18, 95% CI: 1.22– 3.92, p = 0.009) and NBCSS (HR = 2.04, 95% CI: 1.02– 4.08, p = 0.044).Conclusion: ACCI was indeed an effective indicator of the effects of comorbidities on survival among elderly patients with BC. However, the co-effect from age and comorbidities was not significant enough on cancer-specific prognosis, although it exerted a significant effect on treatments received.Keywords: comorbidity, elderly, breast cancer, Age-adjusted Charlson Comorbidity Index, prognosis

BACKGROUND: The incidence of hip fracture patients is increasing day by day. Because of their poor physical condition, these people often need to stay in hospital for a long time. However, the prolonged length of stay leads to a decrease in bed circulation rate and an increase in economic burden. At present, there are few prediction models for delayed discharge of hip fractures. This study aims to find the best model for delayed discharge of hip fractures and guide clinical decision-making. OBJECTIVE: To explore the risk factors of prolonged length of stay in patients with hip fractures, establish two different risk prediction models, obtain the best risk prediction tools, and provide a reference for clinical intervention and management METHODS: Data from 683 elderly patients with hip fractures in Tianjin Hospital from January 2019 to December 2021 were retrospectively analyzed. All patients were randomly divided into a modeling group (479 cases) and a verification group (204 cases) according to the ratio of 7:3. The 75th percentile of length of stay was taken as the cut-off point (> 28 days), and they were divided into extended hospitalization group and normal group. Single-factor and multifactor Logistic regression analysis and variable importance ranking were used to screen the best prediction model; the nomogram and random forest models were constructed. The prediction efficiency of the two models was evaluated by the receiver operating characteristic curve area, accuracy, sensitivity, specificity, positive prediction value and negative prediction value. RESULTS AND CONCLUSION: (1) Logistic regression analysis showed that bone traction, pneumonia, refolding, multiple trauma, venous thrombosis, lung infection and age-adjusted Charlson Comorbidity Index were the risk factors of prolonged length of stay of hip fracture patients. (2) The random forest model showed that age, bone traction, surgical type, age-adjusted Charlson Comorbidity Index and pneumonia were the first five indexes according to the average reduction of the Gini index, which had an important influence on the prediction of delayed discharge. (3) The area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, positive prediction value and negative prediction value of the Logistic regression model and random forest prediction model were 0.774(95%CI: 0.696-0.853) and 0.708(95%CI: 0.627-0.789), 60.78% and 90.85%, 80.39% and 23.53%, 50.82% and 78.09%, 86.01% and 46.15%, respectively. The results exhibited that the Logistic model had good prediction efficiency. (4) Above findings confirm that the Logistics regression model and random forest model have high predictive value for a prolonged length of stay in patients with hip fractures, which is of great significance for clinical medical staff to identify high-risk patients in time and take effective intervention measures to reduce the length of stay of patients with hip fractures. [ABSTRACT FROM AUTHOR]

Background: Concomitant diseases often occur in cancer patients and are important in decision-making regarding treatments. However, information regarding the prognostic relevance of comorbidities for mortality risk is still limited among Chinese gastric cancer (GC) patients. This study aimed to investigate the association between comorbidities and 3-year mortality risk. Methods: This retrospective study enrolled 376 GC patients undergoing radical gastrectomy at the Affiliated Zhongshan Hospital of Dalian University from January 2011 to December 2019. Demographic and clinicopathological information and treatment outcomes were collected. Patients were divided into low-, moderate- and high-risk comorbidity groups based on their Charlson Comorbidity Index (CCI) and age-adjusted CCI (ACCI) scores. Kaplan-Meier survival and Cox regression analyses were used to examine 3-year overall survival (OS) and mortality risk for each group. Results: The median follow-up time was 43.5 months, and 40.2% (151/376) of GC patients had died at the last follow-up. There were significant differences in OS rates between ACCI-based comorbidity groups (76.56; 64.51; 54.55%, log-rank P = 0.011) but not between CCI-based comorbidity groups (log-rank P = 0.16). The high-risk comorbidity group based on the ACCI remained a significant prognostic factor for 3-year OS in multivariate analysis, with an increased mortality risk (hazard ratio [HR], 1.99; 95% CI, 1.15–3.44). Subgroup analysis revealed that this pattern only held for male GC patients but not for female patients. Conclusion: The present study suggested that high-risk comorbidities were significantly associated with a higher mortality risk, particularly in Chinese male GC patients. Moreover, the ACCI score was an independent prognostic factor of long-term mortality. [ABSTRACT FROM AUTHOR]

Abstract Background Cardiac arrest is currently one of the leading causes of mortality in clinical practice, and the Charlson Comorbidity Index (CCI) is widely utilized to assess the severity of comorbidities. We aimed to evaluate the relationship between the age-adjusted CCI score and in-hospital mortality in intensive care unit (ICU) patients with the diagnosis of cardiac arrest, which is important but less explored previously. Methods This was a retrospective study including patients aged over 18 years from the MIMIC-IV database. We calculated the age-adjusted CCI using age information and ICD codes. The univariate analysis for varied predictors’ differences between the survival and the non-survival groups was performed. In addition, a multiple factor analysis was conducted based on logistic regression analysis with the primary result set as hospitalization death. An additional multivariate regression analysis was conducted to estimate the influence of hospital and ICU stay. Results A total of 1772 patients were included in our study, with median age of 66, among which 705 (39.8%) were female. Amongst these patients, 963 (54.3%) died during the hospitalization period. Patients with higher age-adjusted CCI scores had a higher likelihood of dying during hospitalization (P

Purpose: Objective nutritional scoring systems using preoperative blood samples have shown the potential to predict the postoperative outcomes of patients with non-small cell lung cancer (NSCLC). However, it remains unclear whether the prognostic impact depends on age and comorbid burdens. We conducted this study to validate the impact of preoperative nutritional status, stratified with age and comorbidity. Methods: We reviewed the preoperative prognostic nutritional index (PNI) and postoperative outcomes of 713 consecutive patients with completely resected NSCLC. Results: We identified the optimal cutoff values of the PNI as 46. Significantly higher postoperative complication rates and worse survival rates were observed in the low PNI (≤ 46) group, regardless of age/comorbidity burdens. Multivariate analysis showed that a low PNI (≤ 46) was an independent prognostic factor for poor overall survival (hazard ratio: 2.5). A matched-pair analysis gave consistent results, showing that a low PNI (≤ 46) was an independent prognostic factor for poor overall survival (OS; hazard ratio: 1.8) and recurrence-free survival (RFS; hazard ratio: 1.6). Conclusion: Nutritional status, indexed by the PNI, is a strong prognostic factor for the postoperative outcomes of patients undergoing curative resection for NSCL, regardless of age/comorbidity burdens. [ABSTRACT FROM AUTHOR]

Background: Cardiac arrest is currently one of the leading causes of mortality in clinical practice, and the Charlson Comorbidity Index (CCI) is widely utilized to assess the severity of comorbidities. We aimed to evaluate the relationship between the age-adjusted CCI score and in-hospital mortality in intensive care unit (ICU) patients with the diagnosis of cardiac arrest, which is important but less explored previously. Methods: This was a retrospective study including patients aged over 18 years from the MIMIC-IV database. We calculated the age-adjusted CCI using age information and ICD codes. The univariate analysis for varied predictors' differences between the survival and the non-survival groups was performed. In addition, a multiple factor analysis was conducted based on logistic regression analysis with the primary result set as hospitalization death. An additional multivariate regression analysis was conducted to estimate the influence of hospital and ICU stay. Results: A total of 1772 patients were included in our study, with median age of 66, among which 705 (39.8%) were female. Amongst these patients, 963 (54.3%) died during the hospitalization period. Patients with higher age-adjusted CCI scores had a higher likelihood of dying during hospitalization (P < 0.001; OR: 1.109; 95% CI: 1.068–1.151). With the age-adjusted CCI incorporated into the predictive model, the area under the receiver operating characteristic curve was 0.794 (CI: 0.773–0.814), showing that the prediction model is effective. Additionally, patients with higher age-adjusted CCI scores stayed longer in the hospital (P = 0.026, 95% CI: 0.056–0.896), but there was no significant difference between patients with varied age-adjusted CCI scores on the days of ICU stay. Conclusion: The age-adjusted CCI is a valid indicator to predict death in ICU patients with cardiac arrest, which can offer enlightenment for both theory literatures and clinical practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the safety of urgent laparoscopic cholecystectomy (Lap-C) for grade II acute cholecystitis (AC) in high-risk patients who were defined by Tokyo Guideline 18 as having age-adjusted Charlson comorbidity index ≥6 or American Society of Anesthesiologists physical status classification (ASA-PS) ≥ 3, compared with elective Lap-C following percutaneous transhepatic gallbladder drainage (PTGBD). In 73 grade II AC patients who underwent Lap-C from January 2012 to March 2021, 35 were identified as high-risk; 22 underwent urgent Lap-C (urgent group) and 13 PTGBD followed by elective Lap-C (elective group). Surgical and perioperative outcomes were analyzed. There was no significant difference in operation time (median: 101 min vs 125 min; P = 0.371), blood loss (25 ml vs 7 ml; P = 0.853), morbidity rate (31.8% vs 38.5%; P = 0.726), or the incidence of total perioperative major complications (13.6% vs 15.4%; P = 1.000) between the two groups. The total duration of treatment was significantly shorter in the urgent group than the elective group (11 days vs 71 days; P < 0.001). Multivariate analysis revealed that blood loss ≥45 ml [odds ratio (OS): 12.14, 95% confidence interval (CI): 2.03–72.42, P = 0.006], and age ≥75 years with ASA-PS ≥ 3 (OS: 9.85, 95%CI: 1.26–77.26, P = 0.03) were the independent risk factors for total perioperative major complications. In well-selected high-risk patients with grade II AC, urgent Lap-C can be performed with comparable safety to elective Lap-C following PTGBD. [ABSTRACT FROM AUTHOR]

Abstract Background For recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy. Age and the Karnofsky Performance Status Scale (KPSS) are used to make decisions for these patients as these are established as prognostic factors in the initial diagnosis of GB. This study’s aim was to evaluate preoperative patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for recurrent GB patients. Methods In this retrospective analysis we could include 123 patients with surgery for primary recurrence of GB from January 2007 until December 2016 (43 females, 80 males, mean age 57 years (range 21–80 years)). Preoperative age, sex, ACCI, KPSS and adjuvant treatment regimes were recorded for each patient. Extent of resection (EOR) was recorded as a complete/incomplete resection of the contrast-enhancing tumor part. Results Median overall survival (OS) was 9.0 months (95% CI 7.1–10.9 months) after first re-resection. Preoperative KPSS > 80% (P

ObjectivesThis retrospective study aimed to describe our institutional experience with cytoreductive cystectomy (Cx) in patients with pathological T4 (pT4) bladder cancer (BCa) and to investigate the clinicopathologic factors that can predict patient survival outcomes.MethodsWe reviewed the baseline demographics, clinicopathologic features, perioperative complications, and follow-up data of 44 patients who underwent Cx for pT4 BCa at our institution between 2013 and 2021. The Kaplan–Meier curve and the log-rank test were used to analyze progression-free survival (PFS) and overall survival (OS). Univariate and multivariate analyses were performed using the Cox regression model.ResultsThe median age of the patients was 68 years [95% confidence interval (CI) 49–81]. Overall, 21 patients (47.7%) were estimated to have a high age-adjusted Charlson comorbidity index (ACCI) score (>4), and nine patients (20.5%) had pT4b substage BCa. None of the patients died of complications within 30–90 days after surgery. Severe complications occurred in 16% (n = 7) of patients within 30–90 days. During a median follow-up of 51 months, disease progression was detected in 25 patients (56.8%), and 29 patients (65.9%) died of any cause. The median PFS and OS were 15.0 and 21.0 months, respectively. The Kaplan–Meier analysis indicated that patients with high ACCI scores or pT4b BCa had worse PFS (P = 0.003 and P = 0.002, respectively) and OS (P = 0.016 and P = 0.034, respectively) than those with low ACCI scores or pT4a BCa. On multivariate analysis, pT4b substage [hazard ratio (HR), 4.166; 95% CI, 1.549–11.206; P = 0.005] and ACCI score >4 (HR, 2.329; 95% CI, 1.105–4.908; P = 0.026) remained independent risk factors for PFS and OS, respectively.ConclusionOur study revealed that the pT4b substage is associated with a poor prognosis and that the ACCI score is a relevant and practical method to evaluate survival outcomes in patients with pT4 BCa after Cx.

BackgroundThis study aimed to evaluate the clinical association between the age-adjusted Charlson comorbidity index (aCCI) and postoperative mortality in elderly patients.Materials and methodsElderly patients with hip fractures were screened from January 2015 to September 2019. After demographic and clinical characteristics were collected, linear and non-linear multivariate Cox regression models were used to identify the association between the aCCI and mortality. All analyses were performed using EmpowerStats and R software.ResultsA total of 2,657 patients were included in the study, and the mean follow-up duration was of 38.97 months. The mean aCCI score was 4.24 ± 1.09, and 977 (34.14%) died of all-cause mortality. The fully-adjusted linear multivariate Cox regression models showed the aCCI to be associated with mortality [hazard ratio (HR) = 1.31, 95% confidence interval (CI):1.21–1.41, P < 0.0001]. Patients in Q2 showed greater mortality (HR = 1.60, 95% CI: 1.23–2.09; P = 0.0005) than those in Q1; patients in Q3 showed greater mortality (HR = 2.18, 95% CI: 1.66–2.87; P < 0.001) than those in Q1. In addition, the P-value for the trend also showed a linear association in the three models (P < 0.0001). In the sensitivity analysis, propensity score matching was used, and the results were stable.ConclusionThe mortality risk of hip fractures increased by 31% when the aCCI increased by one unit. aCCI score was shown to be a good predictor of three-year mortality following hip fracture.Clinical trial registrationhttp://www.chictr.org.cn/showproj.aspx?proj=152919, identifier ChiCTR2200057323.

We aimed to investigate whether the age-adjusted Charlson comorbidity index (ACCI) can predict the postoperative overall survival (OS) and cancer-specific survival (CSS) of esophageal squamous cell carcinoma (ESCC) patients. Between 1 July 2015 and 31 July 2021, a retrospective cohort study was conducted among patients with primary ESCC who underwent radical esophagectomy. A total of 352 patients were included, with median age of 63.00 (IQR (interquartile range) 56.00–68.00). The patients were divided into low (n = 300) and high (n = 52) ACCI groups based on the optimal cut-off value of 5 points. Chronic pulmonary disease (38.4%) was the most common comorbidity. The results of the multivariate Cox regression showed that the ACCI (HR = 1.63, 95%CI: 1.04–2.56), tumor size (HR = 1.67, 95%CI: 1.05–2.66), pTNM (II vs. I, HR = 4.74, 95%CI: 1.82–12.32; III vs. I, HR = 6.08, 95%CI: 2.37–15.60), and postoperative chemotherapy (HR = 0.60, 95%CI: 0.40–0.91) were significantly associated with the OS. Furthermore, the ACCI, tumor size, pTNM, and postoperative chemotherapy were also significantly associated with the CSS. Interactions were identified between the ACCI and postoperative chemotherapy, pTNM stage, and tumor size in relation to the OS and CSS. In conclusion, the ACCI may be an independent prognostic factor affecting the long-term prognosis of patients after radical esophagectomy. [ABSTRACT FROM AUTHOR]

BackgroundPost-operative delirium (POD) presents as a serious neuropsychiatric syndrome in the elderly undergoing thoracic and abdominal surgery, which is mostly associated with poor prognosis. The Age-adjusted Charlson Comorbidity Index (ACCI) has been widely recognized as an independently predictive factor for overall survival rate and mortality in various surgeries. However, no studies demonstrated the potential relationship between ACCI and POD. The current study was to explore the correlation between ACCI and POD, and determine the predictive effect of ACCI on POD in the elderly after thoracic and abdominal surgery.Materials and methodsTotal 184 patients (≥60 years) who underwent thoracic and abdominal surgery from 2021.10 to 2022.5 were enrolled in this prospective observational cohort study. ACCI was calculated by weighting comorbidities and age. POD was diagnosed using Confusion Assessment Method (CAM) twice a day in the first 3 days after surgery. The Visual Analog Scale (VAS) was applied to measure pre-operative and post-operative pain at rest and in motion. All demographic and perioperative data were compared in patients with POD and without POD. ACCI and other variables were analyzed by univariate and multivariate logistic regression analysis. The characteristic curve of receiver operating characteristic (ROC) was used to further evaluate the accuracy of ACCI to predict POD.ResultsPost-operative delirium was diagnosed in 36 of 184 patients included in our study. The prevalence of POD in the elderly after thoracic and abdominal surgery was 19.6%. The outcomes by multivariate regression analysis showed the independent risk factors for POD were ACCI (OR: 1.834; 95%CI: 1.434–2.344; P < 0.001), pre-operative Mini-Mental State Examination (MMSE) scores (OR: 0.873; 95%CI: 0.767–0.994; P = 0.040), serum albumin (OR: 0.909; 95%CI: 0.826–1.000; P = 0.049) and pain scores in the post-operative third day (OR: 2.013; 95%CI: 1.459–2.778; P < 0.001). ACCI can predict POD more accurately with the largest area under curve (AUC) of 0.794 and sensitivity of 0.861, respectively.ConclusionAge-adjusted Charlson Comorbidity Index, pre-operative MMSE scores, serum albumin and post-operative pain were independently associated with POD in geriatric patients following thoracic and abdominal surgery. Moreover, ACCI may become an accurate indicator to predict POD early.

Objective: Comorbidity scores are increasingly used to reduce potential confounding in oncologic research. This is of paramount importance in endometrial cancer (EC) since it is characterized by quite indolent behavior. Here, we aim to evaluate the impact of various comorbidities and concurrent medications used on survival outcomes, adopting the age-adjusted Charlson comorbidity index (A-CCI). Design: This is an observational study. Charts of 257 EC patients were retrieved. Methods: We retrospectively evaluated data of patients who underwent surgical treatment for EC. A-CCI was calculated by summing the weighted comorbidities and age of each patient. A binomial value was assigned to different comorbidities and different drugs. Oncologic outcomes were evaluated using Cox proportional hazard models adjusted for age. Results: A-CCI ≥3 correlated with more aggressive tumor features (47.6% vs. 26.8%, p = 0.001), higher risk of recurrence (29.7% vs. 11.6%, p = 0.001), death (20.7% vs. 7.1%, p = 0.002), and death due to disease (16.6% vs. 6.3%, p = 0.012). Considering comorbidities and drugs at parsimonious multivariable analysis model: cardiac disease, liver disease, and proton pump inhibitors (PPIs) use were independent predictors of disease-free survival. Cardiac disease, autoimmune disease, and PPIs use were independent predictors of overall survival. Diabetes was the only independent predictor for cause-specific survival. Limitations: The major limitation of the present study is its retrospective nature and the relatively small sample size that limit the possibility to have firm conclusions. Conclusion: Patients with EC are characterized by a high burden of comorbidities. Comorbidities are associated directly with survival outcomes. Further attention is needed to improve the active management of comorbidities soon after EC treatments. Interventional studies are needed to improve patients' outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The age-adjusted Charlson comorbidity index (ACCI) is a useful measure of comorbidity to standardize the evaluation of elderly patients and has been reported to predict mortality in various cancers. To our best knowledge, no studies have examined the relationship between the ACCI and survival of elderly patients with cancer. Therefore, the primary objective of this study was to investigate the relationship between the ACCI and survival of elderly patients with cancer. Patients and Methods: A total of 64 elderly patients (> 80 years) with cancer between 2011 and 2021 were enrolled in this study. According to the ACCI, the age-adjusted comorbidity index was calculated by weighting individual comorbidities; patients with ACCI< 11 were considered the low-ACCI group, whereas those with ACCI≥ 11 were considered the high-ACCI group. The correlations between the ACCI score and survival outcomes were statistically analyzed. Results: There was a significant difference in overall survival (OS) and progression-free survival (PFS) between the high-ACCI group and the low-ACCI group (P< 0.001). The median OS time of the high-ACCI group and the low-ACCI group were 13.9 (10.5– 22.0) months and 51.9 (34.1– 84.0) months, respectively. The 2-, 3-, and 5-year survival rates of the high-ACCI group were 28.1%, 18.8%, and 4.2%, respectively, whereas the 2-, 3-, and 5-year survival rates of the low-ACCI group were 77.3%, 66.4%, and 39.1%, respectively. Multivariate analysis showed that ACCI was independently associated with OS (HR=1.402, 95% CI: 1.226– 1.604, P < 0.05) and PFS (HR=1.353, 95% CI: 1.085– 1.688, P = 0.0073). Conclusion: The ACCI score is a significant independent predictor of prognosis in elderly patients with cancer. [ABSTRACT FROM AUTHOR]

BackgroundIdentifying a high-risk group of older people before surgical procedures is very important. The study aimed to explore the association between the age-adjusted Charlson comorbidity index (ACCI) and all-cause mortality and readmission among older Chinese surgical patients (age ≥65 years).MethodsA large-scale cohort study was performed in 25 general public hospitals from six different geographic regions of China. Trained registered nurses gathered data on clinical and sociodemographic characteristics. All-cause mortality was recorded when patients died during hospitalization or during the 90-day follow-up period. Readmission was also tracked from hospital discharge to the 90-day follow-up. The ACCI, in assessing comorbidities, was categorized into two groups (≥5 vs.

Background: The prognostic nutritional index (PNI) and Charlson comorbidity index (CCI) have been useful for predicting the prognosis based on nutritional condition and comorbidities in surgery and endoscopic mucosal dissection. The age-adjusted CCI (ACCI) has also been reported to be useful in surgery, but it has not been applied to endoscopic treatment. We therefore clarified the prognostic factors associated with ampullary tumors treated with endoscopic papillectomy (EP).Methods: From January 2003 to December 2020, 236 patients who underwent EP for sporadic ampullary tumors at Nagoya University Hospital were included in this study. The 5-year survival and ability to predict the prognosis were evaluated in terms of the sex, PNI, ACCI, final pathological diagnosis, and intraductal extension.Results: During a median follow-up period of 1558 days, 17 patients died. No patient died of the primary disease. The 5-year survival rate was 91.1%. In a univariate analysis, only a high ACCI (≥ 5) was extracted as a significant prognostic factor (Odds ratio, 12.2; 95% confidence interval, 3.81-39.3; p < 0.001). The 5-year survival rates for a low ACCI (≤ 4) and high ACCI were 96.6% and 73.5%, respectively (p < 0.001).Conclusions: A high ACCI is an important prognostic factor associated with the 5-year survival and a risk of death from other illness. Ampullary tumors suitable for EP are less likely to be a prognostic factor, and treatment-free follow-up may be acceptable in patients with a high ACCI. [ABSTRACT FROM AUTHOR]

Background: For recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy. Age and the Karnofsky Performance Status Scale (KPSS) are used to make decisions for these patients as these are established as prognostic factors in the initial diagnosis of GB. This study's aim was to evaluate preoperative patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for recurrent GB patients.Methods: In this retrospective analysis we could include 123 patients with surgery for primary recurrence of GB from January 2007 until December 2016 (43 females, 80 males, mean age 57 years (range 21-80 years)). Preoperative age, sex, ACCI, KPSS and adjuvant treatment regimes were recorded for each patient. Extent of resection (EOR) was recorded as a complete/incomplete resection of the contrast-enhancing tumor part.Results: Median overall survival (OS) was 9.0 months (95% CI 7.1-10.9 months) after first re-resection. Preoperative KPSS > 80% (P < 0.001) and EOR (P = 0.013) were associated with significantly improved survival in univariate analysis. Including these factors in multivariate analysis, preoperative KPSS < 80 (HR 2.002 [95% CI: 1.246-3.216], P = 0.004) and EOR are the only significant prognostic factor (HR 1.611 [95% CI: 1.036-2.505], P = 0.034). ACCI was not shown as a prognostic factor in univariate and multivariate analyses.Conclusion: For patients with surgery for recurrent glioblastoma, the ACCI does not add further information about patient's prognosis besides the well-established KPSS and extent of resection. [ABSTRACT FROM AUTHOR]

Objective:We aimed to determine the risk factors related to patient, tumor characteristics and surgery that may be associated with decline in renal function during follow-up after partial nephrectomy (PN).Materials and Methods:Sixty-one patients who underwent PN due to localized stage Ia renal cell carcinoma between January 2010 and October 2018 were retrospectively analyzed. Demographic characteristics of the patients, clinical and pathological data, information about surgical techniques, preoperative score to predict postoperative mortality (POSPOM), Age-adjusted Charlson Comorbidity index (ACCI), Eastern Cooperative Oncology Group score, American Society of Anesthesiologists’ score, preoperative estimated glomerular filtration rate (eGFR) and eGFR levels during postoperative follow-up were recorded.Results:Twelve (19.7%) patients experienced a decline in eGFR (

Purpose: The association between the age-adjusted Charlson Comorbidity Index (ACCI) and sarcopenia in patients with gastric cancer (GC) remains ambiguous. This study aimed to investigate the association between the ACCI and sarcopenia and the prognostic value in patients with GC after radical resection. In addition, this study aimed to develop a novel prognostic scoring system based on these factors., Methods: Univariate and multivariate Cox regression analyses were used to determine prognostic factors in patients undergoing radical GC resection. Based on the ACCI and sarcopenia, a new prognostic score (age-adjusted Charlson Comorbidity Index and Sarcopenia [ACCIS]) was established, and its prognostic value was assessed., Results: This study included 1068 patients with GC. Multivariate analysis revealed that the ACCI and sarcopenia were independent risk factors during the prognosis of GC (P = 0.001 and P < 0.001, respectively). A higher ACCI score independently predicted sarcopenia (P = 0.014). A high ACCIS score was associated with a greater American Society of Anesthesiologists score, higher pathologic TNM (pTNM) stage, and larger tumor size (all P < 0.05). Multivariate analysis demonstrated that the ACCIS independently predicted the prognosis for patients with GC (P < 0.001). By incorporating the ACCIS score into a prognostic model with sex, pTNM stage, tumor size, and tumor differentiation, we constructed a nomogram to predict the prognosis accurately (concordance index of 0.741)., Conclusion: The ACCI score and sarcopenia are significantly correlated in patients with GC. The integration of the ACCI score and sarcopenia markedly enhances the accuracy of prognostic predictions in patients with GC., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)

Background: Multiple parameters may be used to prognosticate Coronavirus disease-2019 (COVID-19) patients, which are often expensive laboratory or radiological investigations. We evaluated the utility of age-adjusted Charlson comorbidity index (CCI) as a predictor of outcome in COVID-19 patients treated with remdesivir. Materials and methods: This was a single-center, retrospective study on 126 COVID-19 patients treated with remdesivir. The age-adjusted CCI, length of hospital stay (LOS), need for invasive mechanical ventilation (IMV), and survival were recorded. Results: The mean and standard deviation (SD) of age-adjusted CCI were 3.37 and 2.186, respectively. Eighty-six patients (70.5%) had age-adjusted CCI ≤4, and 36 (29.5%) had age-adjusted CCI >4. Among patients with age-adjusted CCI ≤4, 20 (23.3%) required IMV, whereas in those with age-adjusted CCI >4, 19 (52.8%) required IMV (p <0.05, Pearson's chi-square test). In those with age-adjusted CCI ≤4, the mortality was 18.6%, whereas it was 41.7% in patients with age-adjusted CCI >4 (p <0.05, Pearson's chi-square test). The receiver operating curve (ROC) of age-adjusted CCI for predicting the mortality had an area under the curve (AUC) of 0.709, p = 0.001, and sensitivity 68%, specificity 62%, and 95% confidence interval (CI) [0.608, 0.810], for a cutoff score >4. The ROC for age-adjusted CCI for predicting the need for IMV had an AUC of 0.696, p = 0.001, and sensitivity 67%, specificity 63%, and 95% CI [0.594, 0.797], for a cutoff score >4. ROC for age-adjusted CCI as a predictor of prolonged LOS (≥14 days) was insignificant. Conclusion: In COVID-19 patients, the age-adjusted CCI is an independent predictor of the need for IMV (score >4) and mortality (score >4) but is not useful to predict LOS (CTRI/2020/11/029266). [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the clinical characteristics and prognosis of elderly nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT). Methods: From June 2008 to October 2014, 148 newly diagnosed non-metastatic elderly NPC patients (aged ≥ 70 years) receiving IMRT were recruited. Comorbid condition was evaluated using the age-adjusted Charlson Comorbidity Index (ACCI). Kaplan–Meier method was used to estimate survival rates and the differences were compared using log-rank test. Hazard ratio (HR) and the associated 95% confidence interval (CI) were calculated using Cox proportional hazard model by means of multivariate analysis. Results: The median follow-up time was 66.35 months. Estimated OS rate at 5 years for the entire group was 61.8% (95% confidence interval [CI] 0.542–0.703). The 5-year OS rate of RT alone group was 58.4% (95% [CI] 0.490–0.696) compared with 65.2% (95% [CI] 0.534–0.796) in CRT group (p = 0.45). In patients receiving IMRT only, ACCI score equal to 3 was correlated with superior 5-year OS rate in comparison with higher ACCI score 62.1% (95% [CI] 0.510–0.766) to 48.5% (95% [CI] 0.341–0.689), respectively; p = 0.024). A 5-year OS rate of 63.1% (95% [CI] 0.537–0.741) was observed in patients younger than 75 years old compared with 57.5% (95% [CI] 0.457–0.723) in patients older (p = 0.026). Patients with early-stage disease (I–II) showed better prognosis than patients with advanced-stage (III–IV) disease (5-year OS, 72.3–55.4%, respectively; p = 0.0073). The Cox proportional hazards model suggested that age independently predicted poorer OS (HR, 1.07; 95%CI 1.00–1.15, p = 0.04). Conclusion: The survival outcome of patients aged ≥ 70 years receiving IMRT only was similar to chemoradiotherapy with significantly less acute toxicities. Among the population, age is significantly prognostic for survival outcomes. [ABSTRACT FROM AUTHOR]

Backgrounds: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients. Methods: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed. Results: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = −0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012–1.165) Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality.

Abstract Background Migraine is linked to endothelial dysfunction and is considered to be a systemic vasculopathy. Interestingly, systemic vascular diseases also occur in glaucoma patients and are considered to be vascular risk factors. Whether migraine is simply a concomitant condition in glaucoma patients or a risk factor per se for glaucoma remains unknown. Thus, in the present study, we investigated the risk for open angle glaucoma (OAG) in migraineurs using a 10-year follow-up study that employed a nationwide population-based dataset in Taiwan. Methods This retrospective matched-cohort study used data sourced from the Longitudinal Health Insurance Database 2000. We included 17,283 subjects with migraine in the study cohort and randomly selected 69,132 subjects from the database for the comparison group. Each subject in this study was individually traced for a 10-year period to identify those subjects who subsequently received a diagnosis of OAG. The age-adjusted Charlson’s comorbidity index (ACCI) score was utilized to compute the burden of comorbidity in each subject. Multivariate regression analysis was used to assess risk factors for OAG in migraineurs. Cox proportional hazards regression was performed to compare the 10-year risk of OAG between the migraineurs and the comparison cohort. Results Migraineurs had more vascular comorbidities than the comparison cohort. The overall incidence of OAG (per 1000 person-years) was 1.29 and 1.02, respectively, for migraineurs and the comparison cohort during the 10-year follow-up period. Age, hyperlipidemia, and diabetes mellitus were three significant risk factors for OAG in migraineurs. After adjusting for patients’ age and vascular comorbidities, migraineurs were found to have a 1.68-fold (95% confidence interval [CI], 1.20–2.36) greater risk of developing OAG than the comparison cohort, in subjects with an ACCI score of 0. This association became statistically nonsignificant in subjects with ACCI scores of 1–2 or ≥ 3. Conclusion Migraine is associated with a higher risk of OAG for patients with no comorbidity who are aged under 50 years.

Purpose: To report the overall effect of ERAS protocol implementation in patients undergoing radical cystectomy and its impact on the length of hospital stay (LOS) and surgical outcomes considering their comorbid conditions. Methods: Retrospective cohort study including 296 patients (146 non-ERAS patients vs. 150 ERAS patients) undergoing radical cystectomy and urinary diversion from 2010 to 2018. Age-adjusted Charlson Comorbidity Index (ACCI) score eight was set as cut off value between low-risk and high-risk patients. The primary outcome was LOS. Secondary outcomes were time to bowel movements, tolerance of regular diet, the incidence of postoperative ileus, postoperative complications, and 30- and 90-day readmission rates. Results: A higher comorbidity burden was identified in the ERAS group compared to non-ERAS patients (p = 0.04). Median (IQR) LOS for non-ERAS was group 8(4) and 8(5) for ERAS group (p = 0.07). ERAS group demonstrated shorter time to resume bowel movements as well as time to tolerance of regular diet (p = 0.007, p = 0.023, respectively). Low-risk patients managed by the ERAS protocol demonstrated a significantly shortened gastrointestinal (GIT) recovery time (p = 0.001) as well as a reduction of LOS (p = 0.04). No significant reduction of LOS was identified for patients with higher comorbidity when placed on the ERAS protocol (p = 0.65). There were no significant differences in postoperative complications or readmission rates between groups. Conclusion: ERAS protocol implementation following radical cystectomy showed significant improvements in GIT recovery, nevertheless, it did not result in a decrease in LOS or readmission rates. Low-risk patients appeared to derive more benefit from ERAS protocol implementation than high-risk patients. [ABSTRACT FROM AUTHOR]

Background: We investigated the impact of the age‑adjusted Charlson comorbidity index (ACCI) on the pancreatic cancer survival and recurrence after curative surgery followed by adjuvant chemotherapy. Patients and Methods: This study included 155 patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer between 2005 and 2014. The risk factors for the overall survival (OS) and recurrence‑free survival (RFS) were identified. Results: An ACCI of 8 was regarded as the optimum critical point of classification considering the 1‑, 3‑ and 5‑year survival rates. The OS rates at 3 and 5 years after surgery were 25.7% and 19.0% in the ACCI‑low group, respectively, and 7.6% and 0% in the ACCI‑high group, which amounted to a statistically significant difference (P = 0.019). The RFS rates at 3 and 5 years after surgery were 17.3% and 13.8% in the ACCI‑low group, respectively, and 7.1% and 0% in the ACCI‑high group, which amounted to a marginally statistically significant difference (P = 0.104). A multivariate analysis showed that the ACCI was a significant independent risk factor for both the OS and RFS. Conclusions: The ACCI was a risk factor for the OS in patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer. An effective plan is needed for determining the optimum surgical strategy according to the ACCI. [ABSTRACT FROM AUTHOR]

Background: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on the pancreatic cancer survival and recurrence after curative surgery followed by adjuvant chemotherapy.Patients and Methods: This study included 155 patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer between 2005 and 2014. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified.Results: An ACCI of 8 was regarded as the optimum critical point of classification considering the 1-, 3- and 5-year survival rates. The OS rates at 3 and 5 years after surgery were 25.7% and 19.0% in the ACCI-low group, respectively, and 7.6% and 0% in the ACCI-high group, which amounted to a statistically significant difference (P = 0.019). The RFS rates at 3 and 5 years after surgery were 17.3% and 13.8% in the ACCI-low group, respectively, and 7.1% and 0% in the ACCI-high group, which amounted to a marginally statistically significant difference (P = 0.104). A multivariate analysis showed that the ACCI was a significant independent risk factor for both the OS and RFS.Conclusions: The ACCI was a risk factor for the OS in patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer. An effective plan is needed for determining the optimum surgical strategy according to the ACCI. [ABSTRACT FROM AUTHOR]

Background and Aim: Limited data are available on age and comorbidity assessment in patients with biliary tract cancer (BTC). This study aimed to evaluate the association of age and comorbidity burden with clinical outcomes of chemotherapy for BTC. Methods: Consecutive 197 BTC patients undergoing first‐line chemotherapy between 2007 and 2017 were retrospectively studied. Patients were classified to three groups according to the age‐adjusted Charlson comorbidity index (ACCI) excluding the score about BTC and progression‐free survival, overall survival (OS), and safety were compared. Results: Fifty‐one patients (26%) were elderly (≥ 75 years), and ACCI was 0–2 in 73 patients (37%), 3–4 in 98 (50%), and ≥ 5 in 26 (13%). ACCI was associated with the administration of first‐line combination chemotherapy (89% in 0–2, 80% in 3–4, and 64% in ≥ 5, P < 0.01) and second‐line chemotherapy (67% in 0–2, 51% in 3–4, and 35% in ≥ 5, P = 0.01). ACCI was prognostic for OS in addition to performance status, disease status, and CA19‐9: The hazard ratios in ACCI of 3–4 and ≥ 5 were 1.39 and 1.79, compared with ACCI of 0–2 (P = 0.04). While overall safety profile did not differ by ACCI, higher ACCI score group developed Grade 3–4 neutropenia more frequently (26% in 0–2, 42% in 3–4, and 46% in ≥ 5, P = 0.04). Conclusion: Age and comorbidity burden did affect OS and safety profile in BTC patients undergoing first‐line palliative chemotherapy. ACCI can be a simple and useful tool to evaluate the age and comorbidity burden in these patients. [ABSTRACT FROM AUTHOR]

Background/Aim: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on esophageal cancer survival and recurrence after curative treatment. Patients and Methods: This study included 122 patients who underwent curative surgery followed by adjuvant chemotherapy for esophageal cancer between 2005 and 2017. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. Results: An ACCI of 5 was regarded as the optimal critical point of classification considering the survival rates. The OS rates at 3 and 5 years after surgery were 64.2% and 54.4% in the low-ACCI group, respectively, and 42.3% and 29.2% in high-ACCI group, respectively (p=0.035). The RFS rates at 3 and 5 years after surgery were 50.2% and 43.6% in the low-ACCI group, respectively, and 28.5% and 21.3% in high-ACCI group, respectively (p=0.021). A multivariate analysis demonstrated that ACCI was a significant independent risk factor for both the OS and RFS. Conclusion: ACCI is a risk factor for survival in patients who undergo curative treatment for esophageal cancer. An effective plan for the perioperative care and surgical strategy should be developed according to ACCI. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine the risk factors related to patient, tumor characteristics and surgery that may be associated with decline in renal function during follow-up after partial nephrectomy (PN). Materials and Methods: Sixty-one patients who underwent PN due to localized stage Ia renal cell carcinoma between January 2010 and October 2018 were retrospectively analyzed. Demographic characteristics of the patients, clinical and pathological data, information about surgical techniques, preoperative score to predict postoperative mortality (POSPOM), Age-adjusted Charlson Comorbidity index (ACCI), Eastern Cooperative Oncology Group score, American Society of Anesthesiologists' score, preoperative estimated glomerular filtration rate (eGFR) and eGFR levels during postoperative follow-up were recorded. Results: Twelve (19.7%) patients experienced a decline in eGFR (<60 mL/min/1.73 m2) at the postoperative follow-up of median 30 months. Older age, higher Body Mass index, presence of hypertension, Diabetes Mellitus, tumor in the hilar region, higher scores of POSPOM, ACCI, RENAL and PADUA, lower preoperative eGFR, cold ischemia technique, total arterial clamping technique, longer warm ischemia time, longer cold ischemia time and lower preserved renal parenchymal volume (RPV) were found to be associated with both short- and long-term decline in eGFR (<60 mL/ min/1.73 m2). Conclusion: Although lower percentage of preserved RPV is a significant predictor of the postoperative deterioration of renal function, our results have shown that preoperative POSPOM score, ACCI and eGFR levels are just as important as surgical factors. [ABSTRACT FROM AUTHOR]

Objective: Cardiovascular events are the most frequent cause of death or disability among people with systemic lupus erythematosus (SLE). However, the causes of this increased the risk of major adverse cardiovascular events (MACEs) are not completely understood. The Age-adjusted Charlson Comorbidity Index (ACCI) is a prognostic classification that was initially developed for patients who have a number of comorbid conditions and the ACCI has been validated in many clinical settings. Materials and Methods: In this study, 5998 patients were enrolled from the National Health Research Institute Database of Taiwan. All the patients' sequential clinical data related to their diagnosis of SLE were reviewed from 2004 to 2007 to determine their risk of MACE occurrence and of all-cause mortality using their ACCI scores. Results: The predictive accuracy of the ACCI scores in relation to MACE occurrence among SLE patients was estimated and the C-statistic for this curve was found to be 0.687 (95% confidence interval [CI]: 0.664–0.709). The distribution of ACCI scores for MACE patients was 4.7%, 10.3%, 11.4%, and 21.5% for those with ACCI scores in the ranges of 0–1, 2–3, 4–5, and >6, respectively. A plot of the cumulative risk also showed a much higher risk among SLE patients with an ACCI score of >6. When patients were divided into different groups based on their ACCI scores, those with ACCI scores of >6 had an adjusted hazards ratio of 4.88 (95% CI: 3.84–6.19;P< 0.001) as compared to those with ACCI scores of 0–1. Conclusion: SLE patients with higher ACCI scores have a significantly higher risk of a MACE and of all-cause mortality. Our results suggested that ACCI scores may be useful as an index for estimating global cardiovascular risk among patients with SLE.

Beneficial effects of cholecystectomy in acute cholecystitis (AC) might be weakened by complications. The age-adjusted Charlson Comorbidity Index (CCI) assesses disease relevance in the prediction of one-year mortality. To evaluate whether age-adjusted CCI predicted complications (including surgical complications, intensive care unit [ICU] admission, and in-hospital death) among patients undergoing cholecystectomy for AC. Associations between age-adjusted CCI and the length of hospital stay have been also evaluated. 271 patients were enrolled at Ospedale Policlinico San Martino (Genoa, Italy) between 2005 and 2013. Clinical data and blood samples were collected. Patients' median age was 67 years. They underwent more frequently video-laparoscopic cholecystectomy with a limited rate of conversion to open cholecystectomy. Surgical complications occurred in 23 patients (8.5%). 6 patients (2.2%) needed ICU admission, while death occurred in 4 patients (1.5%). According to the cut-off point identified by ROC curve, an age-adjusted CCI cut-off value of 5 was found predictive for in-hospital complications also when confounders were considered (OR 1.35, 95% CI 1.02–1.79, p = 0.035). No association between adjusted CCI and the length of hospital stay was found. In patients surgically treated for AC, age-adjusted CCI could represent an additional tool, along with available risk scores, to help surgeons in choosing the best therapeutic option. [ABSTRACT FROM AUTHOR]

We retrospectively investigated outcomes, including pulmonary toxicities, of stereotactic body radiation therapy using RapidArc and a risk-adapted 60% isodose plan for early-stage non-small-cell lung cancer patients. We evaluated patients staged as cT1a–2bN0M0 between 2011 and 2017 and treated with a total dose of 40–60 Gy in five fractions to the 60% isodose line of the maximum dose encompassing the planning target volume with curative intent. Comorbidities and age were rated using an age-adjusted Charlson comorbidity index (AACCI). Factors associated with overall survival (OS) were investigated. A total of 237 patients with 250 lesions were eligible. The median follow-up was 28.0 months. The local recurrence rate at 3 years was 0.8%; none of the patients developed isolated local recurrence. OS, deaths from lung cancer, and deaths from intercurrent disease at 3 years were 72.7%, 8.2% and 19.1%, respectively. On multivariate analysis for correlating factors with OS, AACCI and maximal standardized uptake value on [18F]-fluorodeoxyglucose positron emission tomography/computed tomography remained significant. Grade ≥3 toxicities were limited to radiation pneumonitis in six (2.4%) patients (Grade 3 in four patients and Grade 5 in two patients). Among those, three patients had idiopathic interstitial pneumonia. The total dose was unrelated to the incidence of Grade ≥3 radiation pneumonitis (P = 0.69). Using the 60% isodose prescription and RapidArc, maximal local control was achieved with acceptable toxicities. Although the OS may depend on patient background, dose escalation aiming at higher local control can be beneficial for medically inoperable patients. [ABSTRACT FROM AUTHOR]

Backgrounds: Charlson Comorbidity index (CCI) is a scoring system to predict prognosis and mortality. It exhibits better utility when combined with age, age-adjusted Charlson Comorbidity Index (ACCI). The aim of this study was to evaluate the relationship between ACCI and diurnal variation of blood pressure parameters in hypertensive patients and normotensive patients. Methods: We enrolled 236 patients. All patients underwent a 24-h ambulatory blood pressure monitoring (ABPM) for evaluation of dipper or non-dipper pattern. We searched the correlation between ACCI and dipper or non-dipper pattern and other ABPM parameters. To further investigate the role of these parameters in predicting survival, a multivariate analysis using the Cox proportional hazard model was performed. Results: 167 patients were in the hypertensive group (87 patients in non-dipper status) and 69 patients were in the normotensive group (41 patients in non-dipper status) of all study patients. We found a significant difference and negative correlation between AACI and 24-h diastolic blood pressure (DBP), awake DBP, awake mean blood pressure (MBP) and 24-h MBP and awake systolic blood pressure(SBP). Night decrease ratio of blood pressure had also a negative correlation with ACCI (p = 0.003, r = −0.233). However, we found a relationship with non-dipper pattern and ACCI in the hypertensive patients (p = 0.050). In multivariate Cox analysis sleep MBP was found related to mortality like ACCI (p = 0.023, HR = 1.086, %95 CI 1.012-1.165) Conclusion: ACCI was statistically significantly higher in non-dipper hypertensive patients than dipper hypertensive patients while ACCI had a negative correlation with blood pressure. Sleep MBP may predict mortality. [ABSTRACT FROM AUTHOR]