Comparison between drug therapy-based comorbidity indices and the Charlson Comorbidity Index for the detection of severe
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ORIGINAL ARTICLE
Comparison between drug therapy‑based comorbidity indices and the Charlson Comorbidity Index for the detection of severe multimorbidity in older subjects Alessio Novella1 · Chiara Elli1 · Mauro Tettamanti1 · Alessandro Nobili1 · Aladar Ianes2 · Pier Mannuccio Mannucci3 · Luca Pasina1 · the REPOSI* Investigators Received: 18 June 2020 / Accepted: 1 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background To know burden disease of a patient is a key point for clinical practice and research, especially in the elderly. Charlson’s Comorbidity Index (CCI) is the most widely used rating system, but when diagnoses are not available therapybased comorbidity indices (TBCI) are an alternative. However, their performance is debated. This study compares the relations between Drug Derived Complexity Index (DDCI), Medicines Comorbidity Index (MCI), Chronic Disease Score (CDS), and severe multimorbidity, according to the CCI classification, in the elderly. Methods Logistic regression and Receiver Operating Characteristic (ROC) analysis were conducted on two samples from Italy: 2579 nursing home residents (Korian sample) and 7505 older adults admitted acutely to geriatric or internal medicine wards (REPOSI sample). Results The proportion of subjects with severe comorbidity rose with TBCI score increment, but the Area Under the Curve (AUC) for the CDS (Korian: 0.70, REPOSI: 0.79) and MCI (Korian: 0.69, REPOSI: 0.81) were definitely better than the DDCI (Korian: 0.66, REPOSI: 0.74). All TBCIs showed low Positive Predictive Values (maximum: 0.066 in REPOSI and 0.317 in Korian) for the detection of severe multimorbidity. Conclusion CDS and MCI were better predictors of severe multimorbidity in older adults than DDCI, according to the CCI classification. A high CCI score was related to a high TBCI. However, the opposite is not necessarily true probably because of non-evidence-based prescriptions or physicians’ prescribing attitudes. TBCIs did not appear selective for detecting of severe multimorbidity, though they could be used as a measure of disease burden, in the absence of other solutions. Keywords Multimorbidiy · Older adults · Comorbidity indices · Chronic diseae · Operating characteristic
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40520-020-01706-w) contains supplementary material, which is available to authorized users. * Alessio Novella [email protected] 1
Pharmacotherapy and Appropriateness of Drug Prescription Unit, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy
2
Medical Direcion, Korian Italy, Milan, Italy
3
Scientific Direction, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
Multimorbidity is commonly defined by the presence of two or more chronic diseases in an individual [1, 2], with prevalences ranging from 49 to 99% in the elderly [3–5]. Multimorbidity is associated with worse health outcomes, more complex clini
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