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Charlson Index for Chronic Disease Costs Prediction in Primary Care Patients Charlson et al. 2008 Charlson Index for Chronic Disease Costs Prediction in Primary Care Patients Charlson et al. 200

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To use an adapted comorbidity index to predict total yearly costs, four conditions was added to the original Charlson Comorbidity Index (1987):
- Hypertension, depression, and use of warfarin with a weight of 1.
- Skin ulcers/cellulitis, with a weight of 2.

+6 points

- AIDS includes patients with definite or probable AIDS (i.e. AIDS-related complex), not patients just HIV positive.

+3 points

- Moderate liver disease consists of cirrhosis with portal hypertension, but without bleeding.
- Severe liver disease consists of patients with ascites, chronic jaundice, portal hypertension or a history of variceal bleeding or those who have had liver transplant.

+2 points

- Non-metastatic solid tumor: Other than malignant neoplasm of skin. Exclude if > 5 years from diagnosis.
- Malignant lymphoma includes patients with Hodgkins, lymphosarcoma, Waldenstrom’s macroglobulinemia, myeloma, and other lymphomas.
- Leukemia includes patients with acute and chronic myelogenous leukemia, acute and chronic lymphocytic leukemia, and polycythemia vera.
- Diabetes with end organ damage includes patients with retinopathy, neuropathy, or nephropathy attributable to diabetes.
- Moderate or severe renal disease includes patients with a serum creatinine >3 mg/dl. Severe renal disease includes patients on dialysis, those who had a transplant, and those with uremia.
- Hemiplegia includes patients with a hemiplegia or paraplegia, whether it occurred as a result of a cerebrovascular accident or other condition.
- Skin ulcers/cellulitis: Partial thickness loss of skin over tags or back with open ulcers or two or more episodes of cellulitis requiring treatment with antibiotics, regardless ot etiology.

+1 point

- Diabetes without end organ damage includes all patients with diabetes treated with insulin or oral hypoglycemic, but not diet atone. Diabetes during pregnancy atone is not counted.
- Mild liver disease consists of chronic hepatitis (B or C) or cirrhosis without portal hypertension.
- Ulcer disease includes patients who have required treatment for ulcer disease, including those who have bled from gastric or peptic ulcers.
- Connective tissue disease includes patients with systemic lupus erythemathous, polymyositis, mixed connective tissue disease, rheumatoid arthritis, polymyositis, polymyalgia rheumatica, vasculitis, sarcoidosis, Sjogrens syndrome or any other systemic vasculitis.
- Chronic pulmonary disease includes patients with asthma, chronic bronchitis, emphysema, and other chronic lung disease who have ongoing symptoms such as dyspnea or cough, with mild or moderate activity.
- Dementia includes patients with moderate to severe chronic cognitive deficit resulting in impaired function from any cause.
- Cerebrovascular disease includes patients with a history of a cerebrovascular accident with minor or no residua, and patients who have had transient ischemic attacks. If the CVA resulted in hemiplegia, code only hemiplegia.
- Peripheral vascular disease includes patients with intermittent claudication or those who had a bypass for arterial insufficiency, those with gangrene or acute arterial insufficiency, and those with a treated or untreated thoracic or abdominal aneurysm (6 cm or more).
- Congestive heart failure includes patients who have had exertional or paroxysmal nocturnal dyspnea and who have responded symptomatically (or on physical examination) to digitalis, diuretics, or afterload reducing agents. it does not include patients who are on one of those medications but who have had no response and no evidence of improvement of physical signs with treatment.
- Myocardial infarction includes patients with one or more definite or probable myocardial infarction. These patients should have been hospitalized for chest pain or an equivalent clinical event and have had electrocardiographic and/ or enzyme changes. Patients with electrocardiographic changes atone who have no clinical history are not designated as having had an infarction.
- Depression includes patients who are currently receiving treatment for depression, whether pharmacologic or psychotherapy, or cognitive behavioral therapy, or notes indicating that the patient has probable or definite depression.
- Hypertension includes patients who have systolic pressures >140 mm Hg and/or diastolic pressures >90 mm Hg if without diabetes or renal disease, as well as controlled hypertensives; or patients with diabetes or renal disease who have systolic pressures >140 mm Hg or diastolic pressures >80 mm Hg


Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61(12):1234-40. PMID: 18619805

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