haematology general-medicine

Charlson Comorbidity Index (CCI)

Validated index of 19 comorbid conditions, each weighted by its adjusted relative risk of 1-year mortality (Charlson 1987). Widely used to predict prognosis and adjust outcomes in clinical research across oncology, surgery, and general medicine.

Myocardial infarction (history of MI, not ECG changes)*

Congestive heart failure (CHF)*

Peripheral vascular disease (claudication, bypass, or amputation)*

Cerebrovascular disease (stroke or TIA without residual deficits)*

Dementia*

Chronic pulmonary disease (COPD, asthma requiring treatment)*

Connective tissue disease (rheumatoid arthritis, SLE, polymyositis)*

Peptic ulcer disease (treated, not just antacids)*

Mild liver disease (hepatitis, without portal hypertension)*

Diabetes without end-organ damage*

Diabetes with end-organ damage (retinopathy, neuropathy, nephropathy) (scored instead of uncomplicated diabetes)*

Hemiplegia or paraplegia*

Moderate-severe renal disease (creatinine > 265 micromol/L or dialysis)*

Solid tumour, localised, within the last 5 years (not leukaemia or lymphoma)*

Leukaemia (AML, CML, ALL, CLL)*

Lymphoma (including multiple myeloma and Waldenstrom macroglobulinaemia)*

Moderate-severe liver disease (cirrhosis + portal hypertension, variceal bleeding) (scored instead of mild liver disease)*

Metastatic solid tumour (scored instead of a localised tumour)*

AIDS (not just HIV positive -- defined AIDS condition)*

Score interpretation

No Comorbidity (CCI 0) 0

CCI 0 -- 1-year mortality 12% in the derivation cohort (medical inpatients, Charlson 1987)

→ Low comorbidity burden; standard treatment intensity appropriate; document CCI in clinical letters; use age-adjusted CCI for research and outcomes adjustment; reassess CCI annually or with new diagnoses; CCI is used across oncology, surgery, and general medicine to contextualise outcomes.

Moderate Comorbidity (CCI 1-2) 1–2

CCI 1-2 -- 1-year mortality 26% in the derivation cohort

→ Moderate comorbidity; consider when selecting treatment intensity; document comorbidities and their management; multimorbidity management; medication review (polypharmacy risk); comprehensive geriatric assessment if elderly; shared decision-making regarding aggressive vs conservative treatment for underlying condition; document functional status alongside CCI.

High Comorbidity (CCI 3-4) 3–4

CCI 3-4 -- 1-year mortality 52% in the derivation cohort

→ High comorbidity burden; adjust treatment intensity; consider palliative/supportive care approach for aggressive conditions; geriatric assessment and frailty scoring; advance care planning discussion; ensure adequate symptom management; consider hospice eligibility if prognosis < 6 months; clinical trials may have CCI eligibility criteria -- document for trial screening.

Very High Comorbidity (CCI >= 5) 5–33

CCI >= 5 -- 1-year mortality 85% in the derivation cohort

→ Severe comorbidity; prioritise quality of life over aggressive curative treatments; advance care planning, including resuscitation preferences; palliative care referral; ensure all active comorbidities are optimally managed; avoid futile interventions; comprehensive MDT discussion; document goals of care clearly; social and carer support assessment; spiritual care if appropriate.

Interpretation bands for the Charlson CCI. Apply clinical judgement and local guidance.

References

Charlson ME et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-383.
Deyo RA et al. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-619.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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