Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy

Abstract

Our intent is to examine the predictive role of Charlson comorbidity index (CCI) on mortality of patients with type 2 diabetic nephropathy (DN). Based on the CCI score, the severity of comorbidity was categorized into three grades: mild, with CCI scores of 1-2; moderate, with CCI scores of 3-4; and severe, with CCI scores ≥5. Factors influencing mortality and differences between groups stratified by CCI were determined by logistical regression analysis and one-way analysis of variance (ANOVA). The impact of CCI on mortality was assessed by the Kaplan-Meier analysis. A total of 533 patients with type 2 DN were enrolled in this study, all of them had comorbidity (CCI score >1), and 44.7% (238/533) died. The mortality increased with CCI scores: 21.0% (50/238) patients with CCI scores of 1-2, 56.7% (135/238) patients with CCI scores of 3-4, and 22.3% (53/238) patients with CCI scores ≥5. Logistical regression analysis showed that CCI scores, hemoglobin, and serum albumin were the potential predictors of mortality (P<0.05). One-way ANOVA analysis showed that DN patients with higher CCI scores had lower levels of hemoglobulin, higher levels of serum creatinine, and higher mortality rates than those with lower CCI scores. The Kaplan-Meier curves showed that survival time decreased when the CCI scores and mortality rates went up. In conclusion, CCI provides a simple, readily applicable, and valid method for classifying comorbidities and predicting the mortality of type 2 DN. An increased awareness of the potential comorbidities in type 2 DN patients may provide insights into this complicated disease and improve the outcomes by identifying and treating patients earlier and more effectively.

Conflict of interest statement

Compliance with ethics guidelines: You-qun HUANG, Rong GOU, Yong-shu DIAO, Qing-hua YIN, Wen-xing FAN, Ya-ping LIANG, Yi CHEN, Min WU, Li ZANG, Ling LI, Jing ZANG, Lu CHENG, Ping FU, and Fang LIU declare that they have no conflict of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study. Additional informed consent was obtained from all patients for which identifying information is included in this article.

Figures

Fig. 1

Kaplan-Meier plot of patients stratified by CCI scores The months were calculated from the first time diagnosed as DN to death

Fig. 2

Kaplan-Meier plots of patients stratified by CCI scores and serum albumin (SA) (a) SA

Fig. 3

Kaplan-Meier plots of study patients stratified by CCI scores and Mogensen stages (a) Stage III; (b) Stage IV; (c) Stage V. The months are calculated from the first time diagnosed as DN to death

Fig. 4

Kaplan-Meier plots of study patients stratified by CCI and hemoglobin (HGB) (a) HGB