ESC Congress 2026 Abstract · Oct 26, 2026
Comorbidity burden drives hard outcomes in a cardiovascular cardiac ICU cohort
By Gomes BFO, Dutra GP, Parente HA et al.
Background: Contemporary cardiac intensive care units (CICUs) increasingly care for patients with substantial chronic disease burden. The Charlson Comorbidity Index (CCI) is a validated, weighted score summarizing comorbid conditions (e.g., renal disease, diabetes, malignancy) and serves as an objective proxy of baseline health status and physiological reserve. Purpose: To evaluate the association between CCI and in-hospital mortality in cardiovascular CICU admissions and to describe its relationship with cardiovascular phenotype (LVEF), biomarkers, organ-support requirements, ICU readmission, and length of stay. Methods: Retrospective single-center cohort (July 2011–February 2025). We included admissions with primary cardiovascular diagnosis (ICD-10 chapter I: I00–I99). CCI was analyzed as categories (0, 1–2, ≥3) and continuous (per point). Primary outcome was in-hospital death. Secondary outcomes included post-discharge ICU readmission during index hospitalization, use of invasive mechanical ventilation (MV), and vasopressors, and CICU/hospital length of stay (LOS). Cardiovascular phenotype/biomarkers included LVEF, peak high-sensitivity troponin, and peak creatinine. Associations were assessed using Spearman correlations and multivariable logistic regression (mortality adjusted for age, sex, and LVEF category). Results: The analytic cohort comprised 4,850 cardiovascular admissions (median age 69 years [IQR 57–80], 60.5% male); in-hospital mortality was 4.8% (231/4,850). Mortality increased stepwise across CCI strata: 1.6% (32/2,037) for CCI=0, 4.8% (97/2,013) for CCI 1–2, and 12.8% (102/800) for CCI≥3. After adjustment for age, sex, and LVEF, CCI remained strongly associated with mortality (CCI≥3 vs 0: OR 5.11, 95% CI 3.35–7.81; CCI 1–2 vs 0: OR 2.00, 1.32–3.02; OR 1.33 per CCI point, 1.25–1.42; all p≤0.001). CCI correlated inversely with LVEF (ρ = −0.21; p<0.001) and HFrEF prevalence (LVEF<40) increased across CCI categories (5.5%, 15.8%, 21.1%). CCI correlated with hospital LOS (ρ = 0.33; p<0.001) and CICU LOS (ρ = 0.21; p<0.001); median hospital LOS was 4 (IQR 3–7), 6 (4–12), and 9 (5–20) days across CCI categories. Post-discharge ICU readmission increased with CCI (5.0%, 8.9%, 14.9%), with adjusted OR 2.98 (2.21–4.02) for CCI≥3 vs 0 (p<0.001). Higher CCI was associated with greater organ-support use (adjusted OR for CCI≥3 vs 0: vasopressors 2.95 [1.57–5.51], MV 2.23 [1.00–4.97]). Peak high-sensitivity troponin was available in 80.6% and showed higher values in patients with greater comorbidity burden (P75 6.77 in CCI≥3 vs 3.80 in CCI=0), while peak creatinine increased with CCI (median 0.91, 0.97, 1.10). Conclusion: In a large cardiovascular CICU cohort, Charlson comorbidity burden identifies a worse cardiovascular phenotype, higher resource utilization, longer hospitalization, higher ICU readmission, and markedly higher in-hospital mortality, adding substantial prognostic information beyond age, sex, and LVEF.