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논문분류	춘계학술대회 초록집
제목	Modified charlson comorbidity index considering sarcopenia on mortality of patients with acute kidney injury requiring continuous renal replacement therapy
저자	Jangwook Lee
출판정보	2023; 2023(1):
키워드
초록	Objectives: Sarcopenia related to fracture and frailty has been recently classified as disease (ICD-10-CM code, M62.84), but conventional comorbidity indices did not consider the sarcopenia as a risk factor. Therefore, we aimed to develop a modified Charlson comorbidity index (CCI) with sarcopenia added (mCCI-sarcopenia) in patients with acute kidney injury requiring continuous renal replacement therapy (CRRT), thereby improving risk stratification for mortality. Methods: We collected 2,205 AKI patients from 8 medical centers and measured skeletal muscle area (SMA) from CT images at the level of the 3rd lumbar vertebra. We set cut-off of SMA as 119.3cm2 for male and 74.2cm2 for female, which was suggested in previous research. Seven university hospital cohorts (n=1,063) were included to develop the comorbidity score and the mCCI-sarcopenia was computed by adding the weights of SMA to original CCI. The predictive capability of CCI and mCCI-sarcopenia for mortality was evaluated using c-statistics and continuous Net Reclassification Improvement (cNRI). The validity of the modified index was assessed in a university hospital cohort (n=1,142). Results: The 30-day mortality rate was 52.6% (n=1,160) and 34.8% of the patients (n=733) had sarcopenia in total patients. In both cohorts, individuals without sarcopenia were observed to be younger and had a higher representation of males compared to those with sarcopenia. Significant differences of c statistics were found in comparison between CCI (0.54, 95% CI [0.51-0.58]) and mCCI-sarcopenia (0.56, 95% CI [0.54-0.60]) (p <0.01). In addition, improved net mortality risk reclassification by 12.4 % (95% CI, 10.1 23.8%; p<0.01) relative to the original CCI was found. Conclusions: We suggest that sarcopenia, along with traditional comorbidities, be regarded as one of the essential diseases to assess the underlying risk of patients with severe AKI.
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