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. 2025 Aug 21;15(8):892.
doi: 10.3390/brainsci15080892.

Premorbid Comorbidities as Predictors of Outcome in Ischemic Posterior Fossa Stroke: A Retrospective Evaluation Using the Age-Adjusted Charlson Comorbidity Index

Francesca Culaj  1 , Toska Maxhuni  1 , Stefan T Gerner  1   2   3 , Anne Mrochen  1 , Tobias Braun  1   4 , Priyanka Boettger  5 , Maxime Viard  6 , Hagen B Huttner  1   2   3 , Martin Jünemann  1   2   3 , Omar Alhaj Omar  1   3
Affiliations

Premorbid Comorbidities as Predictors of Outcome in Ischemic Posterior Fossa Stroke: A Retrospective Evaluation Using the Age-Adjusted Charlson Comorbidity Index

Francesca Culaj et al. Brain Sci. .

Abstract

Background: Posterior cranial fossa (PCF) infarctions are associated with elevated mortality rates; however, evidence regarding the prognostic value of comorbidity indices in this context remains scarce. This study investigates the association between the age-adjusted Charlson Comorbidity Index (aCCI) and clinical outcomes in patients with PCF infarctions, aiming to evaluate the aCCI as a prognostic indicator. The aCCI is a validated scoring system that quantifies a patient's burden of chronic diseases, adjusting for age, to estimate overall comorbidity risk. Methods: In this retrospective, single-center analysis spanning two years, patient data were assessed to determine correlations between aCCI scores and clinical outcomes at discharge, specifically the modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS). Structural equation modeling (SEM) was employed to elucidate the relationships among these variables. Results: SEM demonstrated that higher pre-stroke comorbidity burden, as quantified by the aCCI, was significantly associated with increased stroke severity and poorer functional outcomes at discharge. The aCCI exhibited strong direct effects on both NIHSS (path coefficient: 0.70) and mRS (path coefficient: 1.43). Conclusions: Premorbid comorbidities, as measured by the aCCI prior to stroke onset, are significantly correlated with both neurological deficit and functional outcome at discharge in patients with PCF infarctions. These findings underscore the potential utility of the aCCI as a prognostic tool for outcome prediction in this patient cohort.

Keywords: Charlson Comorbidity Index (aCCI); NIH Stroke Scale (NIHSS); comorbidities; modified Rankin Scale (mRS); posterior cranial fossa; stroke.

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Conflict of interest statement

The authors declare no potential conflicts of interest concerning the research, authorship, and publication of this article.

Figures

Figure 1
Figure 1
Flowchart illustrating the selection and inclusion of patient cohorts.
Figure 2
Figure 2
Likert plots depicting the distribution of age−adjusted Charlson Comorbidity Index (aCCI) scores in the patient cohort, stratified by median split.
Figure 3
Figure 3
Structural equation model (SEM) demonstrating the relationship between pre−event aCCI and functional/clinical outcomes at discharge.
See this image and copyright information in PMC

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