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

Crooks, Colin J.; West, Joe; Jepson, Peter

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.

Citation

Crooks, C. J., West, J., & Jepson, P. (2018). A validation study of the CirCom comorbidity score in an English cirrhosis population using the Clinical Practice Research Datalink. Clinical Epidemiology, 2018:10, https://doi.org/10.2147/CLEP.S147535

• Journal Article Type: Article
• Acceptance Date: Nov 20, 2017
• Publication Date: Jan 15, 2018
• Deposit Date: Jan 16, 2018
• Publicly Available Date: Jan 16, 2018
• Journal: Clinical Epidemiology
• Print ISSN: 1179-1349
• Electronic ISSN: 1179-1349
• Publisher: Dove Press
• Peer Reviewed: Peer Reviewed
• Volume: 2018:10
• DOI: https://doi.org/10.2147/CLEP.S147535
• Keywords: cirrhosis, mortality, comorbidity, prognosis, cause of death, cohort
• Public URL: https://nottingham-repository.worktribe.com/output/904621
• Publisher URL: https://www.dovepress.com/a-validation-study-of-the-circom-comorbidity-score-in-an-english-cirrh-peer-reviewed-article-CLEP
• Contract Date: Jan 16, 2018