Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2016 May 5;11(5):e0154627.
doi: 10.1371/journal.pone.0154627. eCollection 2016.

Prediction of Mortality in Incident Hemodialysis Patients: A Validation and Comparison of CHADS2, CHA2DS2, and CCI Scores

Hsun Yang  1 , Yi-Hsin Chen  1   2   3 , Teng-Fu Hsieh  4   5 , Shiun-Yang Chuang  5 , Ming-Ju Wu  6   7   8
Affiliations
Comparative Study

Prediction of Mortality in Incident Hemodialysis Patients: A Validation and Comparison of CHADS2, CHA2DS2, and CCI Scores

Hsun Yang et al. PLoS One. .

Abstract

Background: The CHADS2 and CHA2DS2 scores are usually applied for stroke prediction in atrial fibrillation patients, and the Charlson comorbidity index (CCI) is a commonly used scale for assessing morbidity. The role in assessing mortality with score system in hemodialysis is not clear and comparisons are lacking. We aimed at evaluating CHADS2, CHA2DS2, and CCI scores to predict mortality in incident hemodialysis patients.

Methods: Using data from the Nation Health Insurance system of Taiwan (NHIRD) from 1 January 2005 to 31 December 2009, individuals ≧20 y/o who began hemodialysis identified by procedure code and receiving dialysis for > 3 months were included for our study. Renal transplantation patients after dialysis or PD patients were excluded. We calculated the CHADS2, CHA2DS2, and CCI score according to the ICD-9 code and categorized the patients into three groups in each system: 0-1, 2-3, over 4. A total of 3046 incident hemodialysis patients enrolled from NHIRD were examined for an association between the separate scoring systems (CHADS2, CHA2DS2, and CCI score) and mortality.

Results: CHADS2 and CHA2DS2 scores revealed good predictive value for total mortality (CHADS2 AUC = 0.805; CHA2DS2 AUC = 0.790). However, the CCI score did not reveal a similarly satisfying result (AUC = 0.576).

Conclusions: Our results show that CHADS2 and CHA2DS2 scores can be applied for mortality prediction in incident hemodialysis patients.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Receiver operating characteristics curve for CHADS2, CHA2DS2 and CCI in the prediction of mortality in incident hemodialysis patients.
Fig 2
Fig 2. Mortality risk stratified by CHADS2, CHA2DS2, and CCI score categories.
(A) CHADS2 score. (B) CHA2DS2 score. (C) CCI score.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bradbury BD, Fissell RB, Albert JM, Anthony MS, Critchlow CW, Pisoni RL, et al. Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol. 2007;2(1):89–99. 10.2215/CJN.01170905 . - DOI - PubMed
    1. Collins AJ, Foley RN, Herzog C, Chavers BM, Gilbertson D, Ishani A, et al. Excerpts from the US Renal Data System 2009 Annual Data Report. Am J Kidney Dis. 2010;55(1 Suppl 1):S1–420, A6–7. 10.1053/j.ajkd.2009.10.009 - DOI - PMC - PubMed
    1. Weller JM, Port FK, Swartz RD, Ferguson CW, Williams GW, Jacobs JF Jr. Analysis of survival of end-stage renal disease patients. Kidney Int. 1982;21(1):78–83. . - PubMed
    1. Wright LF. Survival in patients with end-stage renal disease. Am J Kidney Dis. 1991;17(1):25–8. . - PubMed
    1. Khan IH, Catto GR, Edward N, MacLeod AM. Death during the first 90 days of dialysis: a case control study. Am J Kidney Dis. 1995;25(2):276–80. . - PubMed