Charlson Comorbidity Index Score and Risk of Severe Outcome and Death in Danish COVID-19 Patients
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J Gen Intern Med DOI: 10.1007/s11606-020-05991-z © Society of General Internal Medicine 2020
INTRODUCTION
Studies assessing the impact of total comorbidity burden on outcomes of COVID-19 in age- and sex-controlled analyses are lacking. Previous studies identified the following single comorbidities as risk factors for poor COVID-19 outcomes: coronary heart disease, congestive heart failure, cardiac arrhythmia, chronic obstructive pulmonary disease, cancer, and diabetes.1 In this nationwide study of Danish COVID-19 patients, we investigated if Charlson Comorbidity Index Score (CCIS) was associated with the risk of severe outcome and death.
METHODS
In Denmark, all permanent residents are provided a unique personal identification number enabling cross-linkage of complete nationwide healthcare registries. We included all patients diagnosed with COVID-19 until May 3, 2020, using information from the Danish Civil Registration System (holding demographic data) and the Danish National Patient Registry (holding data on all hospital contacts classified according to ICD-10 codes). Data on comorbidities 10 years prior to the date of COVID-19 were identified to calculate the exposure of interest: CCIS of 0, 1–2, 3–4, and > 4.2 Outcomes of interest were (1) a composite of death, diagnosis of severe acute respiratory syndrome (ICD-10: DB972A), intensive care unit (ICU) admission, and (2) death. Logistic regression models adjusted for sex and age as a continuous variable were employed to associate CCIS 1–2, CCIS 3–4, and CCIS > 4 with odds of outcomes. The models were used to estimate the absolute risk of both outcomes according to CCIS groups across ages 40–85 for both sexes.
Daniel Mølager Christensen and Jarl Emanuel Strange contributed equally to this work. Received May 20, 2020 Revised May 20, 2020 Accepted June 12, 2020
RESULTS
A total of 4480 patients were diagnosed with COVID-19, of which 2911 (65.0%), 1112 (24.8%), 288 (6.4%), and 169 (3.8%) had a CCIS of 0, 1–2, 3–4, and > 4, respectively (Table 1). The median age of the total population was 55 years, with the oldest patients in the CCIS 3–4 group (78 years). Overall, 17.8% had severe outcome and 9.3% died. In the CCIS 0 group, 265 (9.1%) had severe outcome and 77 (2.6%) died. In the CCIS 1–2, 3–4, and > 4 groups, 330 (29.7%), 123 (42.7%), and 80 (47.3%) had severe outcome and 197 (17.7%), 85 (29.5%), and 58 (34.3%) died, respectively. The odds of severe COVID-19 were significantly increased in CCIS 1–2 (odds ratio [OR], 1.76 [95% CI, 1.43 to 2.16]), CCIS 3-4 (OR, 2.36 [95% CI, 1.74 to 3.18]) and CCIS > 4 (OR, 2.67 [95% CI, 1.87 to 3.81]) compared with those in CCIS 0. The odds of death were significantly increased for CCIS 1–2 (OR, 2.13 [95% CI, 1.57 to 2.90]), CCIS 3–4 (OR, 3.00 [95% CI, 2.06 to 4.38]), and CCIS > 4 (OR, 3.85 [95% CI, 2.51 to 5.90]) compared with those for CCIS 0. The estimated absolute risks of severe COVID-19 and death were increased for CCIS 1–2, 3–4, and > 4 compared with those for CCIS 0 across ages and sexes (Fig. 1).
DISCUSSION
A Charlso
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