A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink

Crooks, Colin J. and West, Joe and Jepson, Peter (2018) A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink. Clinical Epidemiology, 2018:10 . pp. 107-120. ISSN 1179-1349

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Abstract

Purpose: The CirCom score has been developed from Danish data as a specific measure of comorbidity for cirrhosis to predict all-cause mortality. We compared its performance with the Charlson Comorbidity Index (CCI) in an English cirrhosis population.

Patients and methods: We used comorbidity scores in a survival model to predict mortality in a cirrhosis cohort in the Clinical Practice Research Datalink. The discrimination of each score was compared by age, gender, socioeconomic status, cirrhosis etiology, cirrhosis stage, and year after cirrhosis diagnosis. We also measured their ability to predict liver-related versus non-liver-related death.

Results: There was a small improvement in the C statistic from the model using the CirCom score (C=0.63) compared to the CCI (C=0.62), and there was an overall improvement in the net reclassification index of 1.5%. The improvement was more notable in younger patients, those with an alcohol etiology, and those with compensated cirrhosis. Both scores performed better (C statistic >0.7) for non-liver-related deaths than liver-related deaths (C statistic <0.6), as comorbidity was only weakly predictive of liver-related death.

Conclusion: The CirCom score provided a small improvement in performance over the CCI in the prediction of all-cause and non-liver mortality, but not liver-related mortality. Therefore, it is important to include a measure of comorbidity in studies of cirrhosis survival, alongside a measure of cirrhosis severity.

Item Type: Article
Keywords: cirrhosis, mortality, comorbidity, prognosis, cause of death, cohort
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Epidemiology and Public Health
University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Nottingham Digestive Diseases Centre
Identification Number: https://doi.org/10.2147/CLEP.S147535
Depositing User: Claringburn, Tara
Date Deposited: 16 Jan 2018 08:35
Last Modified: 17 Jan 2018 23:29
URI: http://eprints.nottingham.ac.uk/id/eprint/49109

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