Charlson Comorbidity Index (CCI)
Comorbidity burden and 1-year mortality (original 1987 weights)
Sources last checked: 2026-10-27
Charlson Comorbidity Index (CCI)
Comorbidity burden and 1-year mortality (original 1987 weights)
Mortality figures come from 559 medical inpatients in New York in 1984 and are far higher than under current care; use them to compare burden, not as a personal prognosis. This is the unadjusted 1987 index — the age-adjusted variant (Charlson 1994) is not included because the 1987 mortality bands do not apply to it.
Interpretation
| 0 | 1-year mortality 12 % in the original medical-ward cohort (Charlson 1987). |
|---|---|
| 1–2 | 1-year mortality 26 % in the original cohort. |
| 3–4 | 1-year mortality 52 % in the original cohort. |
| ≥ 5 | 1-year mortality 85 % in the original cohort. |
What is the Charlson Comorbidity Index (CCI)?
The Charlson Comorbidity Index weights 19 conditions by their association with 1-year mortality. Charlson and colleagues derived it in 1987 from 559 medical inpatients at a New York hospital and validated it in a cohort of women with breast cancer, where it predicted 10-year mortality. It is the most widely used comorbidity measure in clinical research.
When to use it
- Describing and adjusting for comorbidity burden in studies and audits
- Structuring a comorbidity summary before surgery, oncology or geriatric assessment
- Comparing case mix between cohorts or wards
When not to use it
- As an individual life-expectancy prediction — the mortality figures are from a 1984 cohort
- When a disease-specific prognostic score exists for the question at hand
How it is calculated
| Criterion | Points |
|---|---|
| Myocardial infarction (history, not ECG changes only) | +1 |
| Congestive heart failure | +1 |
| Peripheral vascular disease (incl. aortic aneurysm ≥ 6 cm) | +1 |
| Cerebrovascular disease (stroke or TIA with minor or no residua) | +1 |
| Dementia | +1 |
| Chronic pulmonary disease | +1 |
| Connective tissue disease | +1 |
| Peptic ulcer disease | +1 |
| Liver disease | |
| None | 0 |
| Mild (chronic hepatitis or cirrhosis without portal hypertension) | 1 |
| Moderate or severe (cirrhosis with portal hypertension ± variceal bleeding) | 3 |
| Diabetes mellitus | |
| None or diet-controlled | 0 |
| Without end-organ damage | 1 |
| With end-organ damage (retinopathy, nephropathy, neuropathy) | 2 |
| Hemiplegia | +2 |
| Moderate or severe renal disease (creatinine > 3 mg/dL, dialysis, transplant, uraemia) | +2 |
| Solid tumour | |
| None | 0 |
| Any tumour without metastases (within the last 5 years) | 2 |
| Metastatic solid tumour | 6 |
| Leukaemia (acute or chronic) | +2 |
| Lymphoma | +2 |
| AIDS (not HIV positivity alone) | +6 |
Clinical pearls and limitations
- Mortality figures come from 559 medical inpatients in New York in 1984 and are far higher than under current care; use them to compare burden, not as a personal prognosis. This is the unadjusted 1987 index — the age-adjusted variant (Charlson 1994) is not included because the 1987 mortality bands do not apply to it.
- Diabetes, liver disease and solid tumour each count once at their highest level — the selectors here prevent double counting.
- The age-adjusted variant (Charlson 1994) adds 1 point per decade from age 50; it is not offered because the 1987 mortality bands do not apply to it.
- Quan 2011 published updated weights for administrative data; scores from different weight sets are not interchangeable.
- Mild versus moderate/severe liver disease turns on portal hypertension.
Frequently asked questions
What does a Charlson score of 3 mean?
In the 1987 derivation cohort, patients scoring 3–4 had a 1-year mortality of 52 %. Modern cohorts show much lower absolute rates; the score remains useful for ranking comorbidity burden.
Is the age-adjusted Charlson included?
No. Age adjustment (Charlson 1994) adds 1 point for each decade from 50 to 80+, but the 1987 mortality bands were built for the unadjusted index.
Does HIV count?
Only AIDS scores (6 points); HIV positivity without AIDS-defining illness is not an item in the original index.
Evidence and guidelines
- Primary source: Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-383.
- Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47(11):1245-1251 (age-adjusted variant).
- Quan H, Li B, Couris CM et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011;173(6):676-682.
Have a follow-up question?
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