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    Charlson Comorbidity Index (CCI)

    Predicts 10-year survival in patients with multiple comorbidities.
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    When to Use

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    <50 years
    0
    50–59 years
    +1
    60–69 years
    +2
    70–79 years
    +3
    ≥80 years
    +4
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    No
    0
    Yes
    +1
    None
    0
    Mild
    +1
    Moderate to severe
    +3
    None or diet-controlled
    0
    Uncomplicated
    +1
    End-organ damage
    +2
    No
    0
    Yes
    +2
    No
    0
    Yes
    +2
    None
    0
    Localized
    +2
    Metastatic
    +6
    No
    0
    Yes
    +2
    No
    0
    Yes
    +2
    No
    0
    Yes
    +6

    Result:

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    Evidence
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    Formula

    Addition of the selected points:

    Variable

    Definition

    Points

    Myocardial infarction

    History of definite or probable MI (EKG changes and/or enzyme changes)

    1

    Congestive heart failure

    Exertional or paroxysmal nocturnal dyspnea and has responded to digitalis, diuretics, or afterload reducing agents

    1

    Peripheral vascular disease

    Intermittent claudication or past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, or untreated thoracic or abdominal aneurysm (≥6 cm)

    1

    Cerebrovascular accident or transient ischemic attack

    -

    1

    Dementia

    Chronic cognitive deficit

    1

    Chronic obstructive pulmonary disease

    -

    1

    Connective tissue disease

    -

    1

    Peptic ulcer disease

    Any history of treatment for ulcer disease or history of ulcer bleeding

    1

    Mild liver disease

    Mild = chronic hepatitis (or cirrhosis without portal hypertension)

    1

    Uncomplicated diabetes

    -

    1

    Hemiplegia

    -

    2

    Moderate to severe chronic kidney disease

    Severe = on dialysis, status post kidney transplant, uremia, moderate = creatinine >3 mg/dL (0.27 mmol/L)

    2

    Diabetes with end-organ damage

    -

    2

    Localized solid tumor

    -

    2

    Leukemia

    -

    2

    Lymphoma

    -

    2

    Moderate to severe liver disease

    Severe = cirrhosis and portal hypertension with variceal bleeding history, moderate = cirrhosis and portal hypertension but no variceal bleeding history

    3

    Metastatic solid tumor

    -

    6

    AIDS*

    -

    6

    Plus 1 point for every decade age 50 years and over, maximum 4 points.

    Note: liver disease and diabetes inputs are mutually exclusive (e.g. do not give points for both "mild liver disease" and "moderate or severe liver disease").

    *This data is from the original Charlson study in 1987, before the widespread availability of effective antiretroviral therapy. We are not aware of any re-evaluations of the CCI using more recent data.

    Facts & Figures

    10-year survival = 0.983^(eCCI × 0.9), where CCI = Charlson Comorbidity Index.

    Literature

    Dr. Mary Charlson

    About the Creator

    Mary Charlson, MD, is the William Foley Professor of Medicine, Chief of General Internal Medicine and the Program Chairperson for the Master of Science Program in Clinical Epidemiology and Health Services Research at Weill Cornell Medical College. She is also a clinical epidemiologist and methodologist. Dr. Charlson has also developed new methods of improving prognostic stratification in acute and chronic illness.

    To view Dr. Mary Charlson's publications, visit PubMed

    About the Creator
    Dr. Mary Charlson