Validation of the Charlson Comorbidity Index for the prediction of 30-day and 1-year mortality in an extensive hip fracture cohort

Abstract Introduction: The aim of our study wasto validate the original Charlson Comorbidity Index (CCI) and adjusted CCIas prediction model for 30-day and 1-year mortality after hip fracture surgery. The secondary aim of this study was to verify each variable of the CCI as a factor associated with 30-day and 1-year mortality. Methods: A prospective database of two level II trauma teaching hospitals in the Netherlands was used. The original CCI from 1987 and the adjusted CCI from 2011 were calculated based on medical history. To validate the original CCI and the adjusted CCI from 2011, the CCI was plotted against the observed 30-day and 1-year mortality, and the area under the curve (AUC) was calculated. Results: In total,3523 patients were included in this cohort study. The mean of the original CCI in this cohort was 5.1 (SD±2.0) and 4.6 (SD±1.9) for the adjusted CCI. The AUCsof the prediction modelswere 0.674 and 0.696 for 30-day mortality for the original and adjusted CCIs, respectively. The AUCsfor 1-year mortality were 0.705 and 0.717 for the original and adjusted CCIs, respectively. Conclusions: A higher original and adjusted CCI is associated with a higher mortality rate. The AUC wasrelatively low for 30-day and 1-year mortality for both the original and adjusted CCIscompared to other prediction models for hip fracture patients in our cohort. The CCI is not recommended for the prediction of 30-day and 1-year mortality in hip fracture patients.