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Charlson Comorbidity Index (CCI)

Charlson Comorbidity Index (CCI)

Predicts 10-year survival by scoring comorbid conditions.

Charlson Comorbidity Index (CCI)

Charlson Comorbidity Index (CCI)

Predicts 10-year survival by scoring comorbid conditions.

Age
Myocardial infarction
history of definite or probable MI
Congestive heart failure
Peripheral vascular disease
Cerebrovascular disease
stroke with mild or no residua or TIA
Dementia
Chronic pulmonary disease
Connective tissue disease
Peptic ulcer disease
Liver Disease
Diabetes Mellitus
Hemiplegia
Moderate or severe renal disease
Tumour
Leukemia
acute or chronic
Lymphoma
AIDS
not just HIV positive
Charlson Comorbidity Index (CCI): 0 98% 10-year survival
0/20 answered · select options to update

Instructions

The Charlson Comorbidity Index (CCI) is a clinical tool used to estimate the 10-year survival of patients by categorizing and scoring comorbid conditions. Each condition is assigned a weight based on its association with mortality, and the sum of these weights forms the patient’s total score. A higher score indicates a greater burden of disease and reduced survival probability. To use the tool, assess the patient’s medical history, identify present comorbidities, assign the appropriate points, and calculate the final score. The tool can be applied both at the bedside and in research contexts.

Overview
When to use
Why use
Evidences

Interpretation

CCI Score

10-Year Survival Estimate

0

98% survival

1–2

90–96% survival

3–4

77–90% survival

5–6

53–77% survival

≥7

0–21% survival

The Charlson Comorbidity Index (CCI) was introduced in 1987 as a weighted index of 19 comorbid conditions to predict 1‑year mortality among hospitalized patients; each condition received weights (1, 2, 3, or 6) derived from hazard ratios, summed to a total score that correlates with mortality risk

https://pubmed.ncbi.nlm.nih.gov/3558716/ 

To enable use with claims/EHR data, coding algorithms mapped the CCI conditions to ICD codes: Deyo et al. (1992) and Romano et al. (1993) created ICD‑9‑CM adaptations (often 17 categories in practice), enabling population studies and risk adjustment

https://healthcaredelivery.cancer.gov/seermedicare/considerations/comorbidity.html

Critical reviews conclude the CCI has excellent inter‑rater reliability, good concurrent and incremental validity, and stepwise increases in mortality with higher scores across diverse medical, surgical, ICU, trauma, and cancer populations, though for short‑term in‑ICU prognosis other purpose‑built scores may perform better

https://karger.com/pps/article/91/1/8/826493/Charlson-Comorbidity-Index-A-Critical-Review-of

In head‑to‑head comparisons for mortality prediction, CCI performs reasonably but may be outperformed by alternative indices (e.g., Elixhauser or pharmacy‑based Rx‑Risk) in certain cohorts or when using administrative data; combining indices can modestly improve discrimination (e.g., c‑statistic gains when adding Rx‑Risk to CCI).

https://pmc.ncbi.nlm.nih.gov/articles/PMC8922332/

Overview
When to use
Why use
Evidences

The Charlson Comorbidity Index (CCI) is one of the most widely used prognostic scoring systems in clinical medicine. Developed in 1987 by Dr. Mary Charlson and colleagues, the index was originally designed to predict 1-year mortality among hospitalized patients by quantifying the impact of comorbid conditions. Over time, it has been extensively validated across multiple populations and diseases, and it remains a cornerstone tool for risk adjustment in both clinical practice and research.

The CCI assigns weighted scores to 17 comorbidities, including cardiovascular disease, diabetes, cancer, liver disease, renal disease, and AIDS/HIV, among others. The weights (ranging from 1 to 6) reflect the relative risk of mortality associated with each condition. For example, a prior myocardial infarction carries 1 point, while metastatic solid tumor or AIDS carries 6 points. Additionally, age can be incorporated into the score, with increasing points added for each decade beyond 40 years, further refining the predictive accuracy.

In practice, the CCI helps clinicians assess prognosis, stratify patients by risk, and guide decision-making in treatment planning. For example, patients with a higher CCI may have a poorer tolerance for invasive procedures, chemotherapy, or surgery, influencing the choice of therapy. In research, the CCI is commonly used to adjust for comorbidity burden in clinical trials and observational studies, allowing for more accurate comparisons between patient populations.

Overview
When to use
Why use
Evidences

Interpretation

CCI Score

10-Year Survival Estimate

0

98% survival

1–2

90–96% survival

3–4

77–90% survival

5–6

53–77% survival

≥7

0–21% survival

The Charlson Comorbidity Index (CCI) was introduced in 1987 as a weighted index of 19 comorbid conditions to predict 1‑year mortality among hospitalized patients; each condition received weights (1, 2, 3, or 6) derived from hazard ratios, summed to a total score that correlates with mortality risk

https://pubmed.ncbi.nlm.nih.gov/3558716/ 

To enable use with claims/EHR data, coding algorithms mapped the CCI conditions to ICD codes: Deyo et al. (1992) and Romano et al. (1993) created ICD‑9‑CM adaptations (often 17 categories in practice), enabling population studies and risk adjustment

https://healthcaredelivery.cancer.gov/seermedicare/considerations/comorbidity.html

Critical reviews conclude the CCI has excellent inter‑rater reliability, good concurrent and incremental validity, and stepwise increases in mortality with higher scores across diverse medical, surgical, ICU, trauma, and cancer populations, though for short‑term in‑ICU prognosis other purpose‑built scores may perform better

https://karger.com/pps/article/91/1/8/826493/Charlson-Comorbidity-Index-A-Critical-Review-of

In head‑to‑head comparisons for mortality prediction, CCI performs reasonably but may be outperformed by alternative indices (e.g., Elixhauser or pharmacy‑based Rx‑Risk) in certain cohorts or when using administrative data; combining indices can modestly improve discrimination (e.g., c‑statistic gains when adding Rx‑Risk to CCI).

https://pmc.ncbi.nlm.nih.gov/articles/PMC8922332/

Frequently Asked Questions

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What does a higher CCI score mean?+
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Model for End-Stage Liver Disease (Combined MELD)