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Cited by 1,686Chronic Disease Management StrategiesFrailty in Older AdultsCardiac, Anesthesia and Surgical Outcomes

Charlson Comorbidity Index: A Critical Review of Clinimetric Properties

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Charlson, Mary E., Carrozzino, Danilo, Guidi, Jenny, Patierno, Chiara·2022·Psychotherapy and Psychosomatics
DOI 10.1159/000521288
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Abstract

The present critical review was conducted to evaluate the clinimetric properties of the Charlson Comorbidity Index (CCI), an assessment tool designed specifically to predict long-term mortality, with regard to its reliability, concurrent validity, sensitivity, incremental and predictive validity. The original version of the CCI has been adapted for use with different sources of data, ICD-9 and ICD-10 codes. The inter-rater reliability of the CCI was found to be excellent, with extremely high agreement between self-report and medical charts. The CCI has also been shown either to have concurrent validity with a number of other prognostic scales or to result in concordant predictions. Importantly, the clinimetric sensitivity of the CCI has been demonstrated in a variety of medical conditions, with stepwise increases in the CCI associated with stepwise increases in mortality. The CCI is also characterized by the clinimetric property of incremental validity, whereby adding the CCI to other measures increases the overall predictive accuracy. It has been shown to predict long-term mortality in different clinical populations, including medical, surgical, intensive care unit (ICU), trauma, and cancer patients. It may also predict in-hospital mortality, although in some instances, such as ICU or trauma patients, the CCI did not perform as well as other instruments designed specifically for that purpose. The CCI thus appears to be clinically useful not only to provide a valid assessment of the patient’s unique clinical situation, but also to demarcate major diagnostic and prognostic differences among subgroups of patients sharing the same medical diagnosis.

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  • The Charlson comorbidity index is the most extensively studied comorbidity index and is considered a valid and reliable method to measure comorbidity in clinical research.

    “The Charlson comorbidity index is the most extensively studied comorbidity index and is considered a valid and reliable method to measure comorbidity that can be used in clinical research [6,14].”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [6]

    The Conclusions state that the CCI is a reliable and valid index for assessing comorbidity in clinical research and practice. The Methods note extensive literature on the CCI, including more than 36,925 citations of its original version, but do not establish that it is the most extensively studied comorbidity index. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Polymorbidity is associated with increased health service utilization and poorer health outcomes.

    “Additionally polymorbidity is associated with increased health service utilization and poorer health outcomes [6,7], demonstrating the relevance of proper treatment for polymorbid patients.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [6]

    The Sensitivity section reports that mortality increased stepwise with increasing comorbidity, supporting the poorer-outcomes part of the claim. The Discussion says the review did not focus on multimorbidity or outcomes such as readmissions, length of stay, and cost. A References entry mentions health service use, but the paper's text does not establish the claimed increase in utilization. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

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200 of 282 shown

Authors
Charlson, M. E., Carrozzino, D., Guidi, J., & Patierno, C.
Affiliations
  • Weill Cornell Medicine (US)
  • University of Bologna (IT)
ORCID
Carrozzino, Danilo
Venue
Psychotherapy and Psychosomatics
Publisher
S. Karger AG
Published
2022
Volume
91
Issue
1
Pages
8-35
ISSN
  • 0033-3190 (ISSN-L)
  • 1423-0348
DOI
10.1159/000521288
OpenAlex
W4205594133
Cited by
1,686
References
192
Citations by year
2026: 431 · 2025: 530 · 2024: 409 · 2023: 250 · 2022: 66
FWCI
49.90
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychotherapy and Psychosomatics (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
Keywords
Charlson Comorbidity Index, comorbidity assessment, long-term mortality prediction, prognostic validity, inter-rater reliability, concurrent validity, incremental validity, sensitivity, in-hospital mortality, intensive care unit patients, trauma patients, cancer patients
MeSH terms
Humans, Prognosis, Retrospective Studies, Reproducibility of Results, Comorbidity, International Classification of Diseases

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