Charlson Comorbidity Index

The Charlson Comorbidity Index is a method of classifying prognostic comorbidity in longitudinal studies.

Some Comorbid Diagnosis have points associated with them that contribute to an overall comorbidity score. This score reflects the cumulative increased likelihood of one year mortality.

The Charlson Index was developed in 1987 based on 1-year mortality data from internal medicine patients admitted to a single New York Hospital and was initially validated within a cohort of breast cancer patients. The index encompasses 19 medical conditions weighted 1–6 with total scores ranging from 0–37. In the development phase of the index, mortality for each disease was converted to a relative risk of death within 12 months. A weight was then assigned to each condition based on the relative risk (RR); for example,

• RR <1.2 = weight 0,
• RR ≥ 1.2<1.5 = weight 1,
• RR ≥ 1.5<2.5 = weight 2,
• RR ≥ 2.5<3.5 = weight 3,
• and for 2 conditions (metastatic solid tumor and AIDS) = weight 6.

From the weighted conditions, a sum score can be tallied to yield the total comorbidity score.

Article and related publications

image of Charlson article, page 2. A PDF of the complete original article can be found on- X:\CCMDB_ADMIN_DATABASE\Charlson_Comorbids\OriginalCharlsonArticlePDF

Article: An electronic application for rapidly calculating Charlson comorbidity score. Article with link to a comorbid score calculator developed in MS Excel using a macro.

• Copy of this calculator can be found: X:\CCMDB_ADMIN_DATABASE\Charlson_Comorbids\comorbid calculator

Charlson Comorbid Diagnosis

Contains 19 primary medical conditions of comorbidity some of which contain subcategories of diseases related to the primary category. For a list of all diagnosis applicable that we use go to: Charlson Comorbid Diagnosis (or Comorbid_Disease-General_Information#Comorbid_List as former may not include all sub-diagnoses).

The Charlson Comorbid Diagnosis codes have been mapped to the Critical Care/Medicine Diagnosis Coding Index which is stored in the S_AllDiagnoses list used in CCMDB.mdb.

Comorbid List

can't replace this with categories because not all sub-codes are included there. 

Myocardial Infarction

• Anterior - 10201
• Anteroseptal - 10202
• Lateral - 10203
• Inferior - 10204
• Posterior - 10205
• Right Ventricular - 10206
• Non Transmural (Non Q) - 10207
• Intraoperative - 10208
• Post OP - 10209

Congestive Heart Failure

• LVF - 10301
• 2nd to Arrhythmias - 10304
• 2nd to Hypertension - 10305
• 2nd to Cardiac Ischemia - 10306
• Etiology NYD - 10307

Peripheral Vascular Disease

• Cerebrovascular disease

• CVA-Cerebral Vascular Accident - 50500

• Dementia
  • Violent 2nd to dementia- not in comorbid list. If coded in admit or acquried this behaviour related to dementia would imply that patient has underlying comorbid DX of Dementia.
    • We don't have a QA check in ccmdb.mdb to check if code 53800 violent behaviour in admit or acquired then comobid of 52600 - dementia should be present in comorbid DX slots.Trish Ostryzniuk 18:26, 2013 February 13 (EST)
      • And should we? Maybe it would be better to just change the Charlson scoring tool and tell collectors to not code both and waste one of the comorbid codes on this. As you said, it's implied, coding it adds no value. I think we should change it that way, and if we then want to add a check that ensures it is not double coded, we can do that. Ttenbergen 10:31, 2013 February 14 (EST) Template:Discussion
      • FYI, List of diagnoses affecting Overstay Project deals with this as well. Ttenbergen 16:18, 2014 September 11 (CDT)

• COPD

• Connective Tissue Disease

• SLE (Systemic Lupus Erytmatosus) - 25000
• Rheumatoid Arthritis - 25100
• Ankylosing Spondylitis - 25200
• Dermatoyositis - 25300
• Mixed Connective Tissue Disease - 25400
• Scleroderma - 25500
• Wegener's Granulomatosis / Granulomatosis with polyangiitis - 25600
• Pulmonary Renal Syndrome (Goodpastures Syndrome) - 25700
• Primary Systemic Vasculitis - 25800
• Sjogrun's Syndrome - 25801
• Other Vasculitis - 258-90
• Polymyositis - - 26000
• CollVasc Diseases - 29900
  • Weber Christian Disease - 29902
  • Polyarthritis - 29903
  • Osteoarthritis - 29904
  • Gout -299-6
  • Erdheim-Chester Disease - 29905
  • Other CollVasc Diseases - 29990

• Ulcer disease

• GI Ulcer - Gastric Ulcer - no HX of bleed - 41502
• Upper GI Bleed - Duodenal Ulcer - 40102
• Upper GI Bleed - Gastric Erosions - 40103
• GI Ulcer - Duodenal (Peptic Ulcer) -no HX of bleed - 41501

Mild Liver disease

• ETOH Liver Disease - Mild - 40787
• Non ETOH Liver Disease - Mild - 40887

Diabetes

• Hemiplegia

• Quadriplegia-post polio - QUADRIPLEGIA-POST POLIO - 51300
• Post Traumatic Quadriplegia - QUADRIPLEGIA-POST TRAUMATIC - 52900
• Paraplegia, Hemiplegia - PARAPLEGIA, HEMIPLEGIA - 53700

Renal Disease:

• Mild definition: Creatinine 160-240 (code is 36487)
• Moderate definition: Creatinine greater than or = 241. (code is 36488)
• Severe definition: on chronic dialysis or renal transplant

• CRF - CRF (Chronic Dialysis) - 35100
• Renal Transplant Surgery - 80500

• Diabetes with end organ damage

• Diabetes - Diabetes-Severe - 30089
• Any tumor

• Head and neck - HEAD AND NECK CA - 70000
• Head and neck - Nonmetastatic - 70002
• Brain - BRAIN CA - 70100
• Brain - Nonmetastatic - 70102
• Mediastinum - MEDIASTINUM CA - 70200
• Mediastinum - Nonmetastatic - 70202
• Pituitary gland - PITUITARY GLAND CA - 70300
• Pituitary gland - Nonmetastatic - 70302
• Thyroid gland - THYROID GLAND CA - 70400
• Thyroid gland - Nonmetastatic - 70402
• Adrenal gland - ADRENAL GLAND CA - 70500
• Adrenal gland - Nonmetastatic - 70502
• Lung - LUNG CA - 70600
• Lung - Nonmetastatic - 70602
• Esophagus - ESOPHAGUS CA - 70700
• Esophagus - Nonmetastatic - 70702
• Stomach - STOMACH CA - 70800
• Stomach - Nonmetastatic - 70802
• Bowel - BOWEL CA - 70900
• Bowel - Nonmetastatic - 70902
• Liver - LIVER CA - 71000
• Liver - Nonmetastatic - 71002
• Pancreas - PANCREAS CA - 71100
• Pancreas - Nonmetastatic - 71102
• Biliary Tree - BILIARY TREE CA - 71200
• Biliary Tree - Nonmetastatic - 71202
• Kidney - KIDNEY CA - 71300
• Kidney - Nonmetastatic - 71302
• Bladder - BLADDER CA - 71400
• Bladder - Nonmetastatic - 71402
• Prostate - PROSTATE CA - 71500
• Prostate - Nonmetastatic - 71502
• Testicle - TESTICLE CA - 71600
• Testicle - Nonmetastatic - 71602
• Ovary - OVARY CA - 71700
• Ovary - Nonmetastatic - 71702
• Uterus - UTERUS CA - 71800
• Uterus - Nonmetastatic - 71802
• Cervix - CERVIX CA - 71900
• Cervix - Nonmetastatic - 71902
• Vagina - VAGINA CA - 72000
• Vagina - Nonmetastatic - 72002
• Breast - BREAST CA - 72100
• Breast - Nonmetastatic - 72102
• Skin - SKIN CA - 72200
• Skin - Nonmetastatic - 72202
• Bone - BONE CA - 72300
• Bone - Nonmetastatic - 72302
• Spinal Cord - SPINAL CORD CA - 72400
• Spinal Cord - Nonmetastatic - 72402
• Thymus - THYMUS CA - 72500
• Thymus - Nonmetastatic - 72502
• Other Tumors - OTHER TUMORS - 74900
• Other Tumors - Nonmetastatic - 74902
  • Note: recurrent tumors intentionally not in this list

Leukemia

• AML - 20000
• ALL - 20100
• CLL - 20200
• CML- 20300
• Multiple Myeloma - 20500
• Multiple Myeloma - Plasma Cell Leukemia - 20501

Lymphoma

• Lymphoma - 20400
• Lymphoma - Non-Hodgkin's - 20401
• Lymphoma - Mixed Non-Hodgkin's - 20402
• Lymphoma - Hodgkin's - 20403

• • Moderate or severe liver disease

• Viral Hepatitis - 7500
• ETOH Liver Disease (moderate) - 40788
• ETOH Liver Disease (severe) - 40789
• Non ETOH Liver Disease (moderate) - 40888
• Non ETOH Liver Disease (severe) - 40889
• Liver Transplant - 42900

• • Metastatic Solid Tumor

• Head and neck - 70001
• Brain - 70101
• Mediastinum - 70201
• Pituitary gland - 70301
• Thyroid gland - 70401
• Adrenal gland - 70501
• Lung - 70601
• Esophagus - 70701
• Stomach - 70801
• Bowel - 70901
• Liver - 71001
• Pancreas - 71101
• Biliary Tree - 71201
• Kidney - 71301
• Bladder - 71401
• Prostate - 71501
• Testicle - 71601
• Ovary - 71701
• Uterus - 71801
• Cervix - 71901
• Vagina - 72001
• Breast - 72101
• Skin - 72201
• Bone - 72301
• Spinal Cord - 72401
• Thymus - 72501
• Primary Site Unknown - 74800
• Primary Site Unknown - Metastatic 74801
• Other Tumors - 74901

AIDS

the list

Template:Discussion not even sure wha this is about... why is it separate from below?

• Noonan's syndrome - NOONAN'S SYNDROME - 88600
• Ghurg-Strauss Syndrome - GHURG-STRAUSS SYNDROME - 86800
• Marfans Syndrome - MARFANS SYNDROME - 87100
• Lung Transplant - LUNG TRANSPLANT SURGERY - 78100
• Emphysema - Moderate - 888
• Idiopathic Pulmonary Fibrosis - Mild - 487
• Idiopathic Pulmonary Fibrosis - Moderate - 488
• Idiopathic Pulmonary Fibrosis - Severe - 489
• Restrictive Lung Disease - Mild - 587
• Restrictive Lung Disease - Moderate - 588
• Restrictive Lung Disease - Severe - 589
• Asthma - Mild - 687
• Asthma - Moderate - 688
• Emphysema - Mild - 887
• Emphysema - Severe - 889
• Cystic Fibrosis - Mild - 1787
• Cystic Fibrosis - Moderate - 1788
• Cystic Fibrosis - Severe - 1789
• Bronchiectasis - Mild - 1887
• Bronchiectasis - Moderate - 1888
• Bronchiectasis - Severe - 1889
• Asthma - Severe - 689

Comorbid Diagnosis

• Comorbid Diagnosis - list of ALL Comorbids disease that we track.
• Charlson Comorbid Diagnosis - list of Comorbid Diagnosis specifically related to Charlson Comorbidity Index scoring.

• Concept:ICD10 Charlson Comorbidity - ICD10 diagnoses with Charlson scores

Collection Start Date

September 14, 1998

Data Use

• MOST score for Medicine
• Some items are use for APACHE II score for Critical Care. For a specific list of chronic condition applicable to APACHE II scoring see: Chronic Health APACHE
• Template:Discussion is this used in Reporting? If so, which? Ttenbergen 01:25, 2017 September 23 (CDT)