The application value of age-adjusted Charlson and Elixhauser-vw comorbidity index in predicting the prognosis of patients undergoing heart valve surgery

Abstract Objective: Comparing the efficacy of the Age-adjusted Charlson Comorbidity Index (ACCI) and the Elixhauser-vw Comorbidity Index (ECI-vw) in predicting mortality risk in patients undergoing heart valve surgery. Methods: Utilizing R language for clinical data extraction from the INSPIRE Database and employing the Receiver Operating Characteristic (ROC) Curve to assess ACCI and ECI-vw with in-hospital all-cause mortality, as well as all-cause mortality within 7 and 28 days post-surgery in patients with heart valve disease. This study further identifies the optimal cutoff value and conducts subgroup analysis to validate their application efficacy. Results: A total of 996 patients were included in the study, comprising 931 survivors and 65 cases of in-hospital all-cause mortality. Of these, 13 patients passed away within 7 days post-surgery, and 32 succumbed within 28 days post-surgery. The area under the curve (AUC) for ACCI in predicting in-hospital all-cause mortality was 0.658 (95% CI: 0.584, 0.732), while the AUC for ECI-vw in predicting the same outcome was 0.663 (95% CI: 0.584, 0.741). For predicting all-cause mortality within 7 days post-surgery, the AUC of ACCI was 0.680 (95% CI: 0.04, 0.56), and for ECI-vw, it was 0.532 (95% CI: 0.353, 0.712). Regarding the prediction of all-cause mortality within 28 days after surgery, the AUC for ACCI was 0.724 (95% CI: 0.622, 0.827), and for ECI-vw, it was 0.653 (95% CI: 0.538, 0.69). Patients were categorized into two groups based on the ACCI cutoff value of 3.5, including Group 1 (ACCI 3.5 points, 173 cases). The overall survival rate for these two patient groups was calculated using the Kaplan-Meier method, revealing that the 28-day postoperative survival rate for patients in Group 1 was significantly higher than that for patients in Group 2 (P <0.0001). Conclusions: ACCI demonstrates significant predictive value for in-hospital all-cause mortality within 28 days following cardiac valve disease surgery. Patients presenting with an ACCI greater than 3.5 exhibit an increased risk of mortality within 28 days post-surgery compared to those with an ACCI less than 3.5. This finding suggests that the ACCI can serve as a preliminary tool for assessing the prognosis of patients undergoing this type of surgical intervention.