Adult Comorbidity Evaluation-27

Identify the important medical comorbidities and grade severity using the index. Overall Comorbidity Score is defined according to the highest ranked single ailment, except in the case where two or more Grade 2 ailments occur in different organ systems. In this situation, the overall comorbidity score should be designated Grade 3.

Cogent comorbid ailment

Grade 3 Severe Decompensation

Grade 2 Moderate Decompensation

MI > 6 months ago Chronic exertional angina Recent ( 6 months) Coronary Artery Bypass Graft (CABG) or Percutaneous Transluminal Coronary Angioplasty (PTCA) Recent ( 6 months) coronary stent Hospitalized for CHF >6 months prior CHF with dyspnea which limits activities Ventricular arrhythmia > 6 months Chronic atrial fibrillation or flutter Pacemaker DBP 115-129 mm Hg DBP 90-114 mm Hg while taking antihypertensive medications Secondary cardiovascular symptoms: vertigo, epistaxis, headaches DVT controlled with Coumadin or heparin Old PE > 6 months Bypass or amputation for gangrene or arterial insufficiency > 6 months ago Chronic insufficiency

Grade 1 Mild Decompensation

MI by ECG only, age undetermined ECG or stress test evidence or catheterization evidence of coronary disease without symptoms Angina pectoris not requiring hospitalization CABG or PTCA (>6 mos.) Coronary stent (>6 mos.) CHF with dyspnea which has responded to treatment Exertional dyspnea Paroxysmal Nocturnal Dyspnea (PND) Sick Sinus Syndrome Supraventricular tachycardia DBP 90-114 mm Hg while not taking antihypertensive medications DBP <90 mm Hg while taking antihypertensive medications Hypertension, not otherwise specified Old DVT no longer treated with Coumadin or Heparin Intermittent claudication Untreated thoracic or abdominal aneurysm (< 6 cm) s/p abdominal or thoracic aortic aneurysm repair Restrictive Lung Disease or COPD (chronic bronchitis, emphysema, or asthma) with dyspnea which has responded to treatment FEV1 (66%-80%)

Cardiovascular System Myocardial Infarct MI 6 months Angina / Coronary Artery Disease Unstable angina

Congestive Heart Failure (CHF)

Hospitalized for CHF within past 6 months Ejection fraction < 20% Ventricular arrhythmia 6 months

Arrhythmias

Hypertension

DBP>130 mm Hg Severe malignant papilledema or other eye changes Encephalopathy Recent PE ( 6 mos.) Use of venous filter for PEs Bypass or amputation for gangrene or arterial insufficiency < 6 months ago Untreated thoracic or abdominal aneurysm (>6 cm)

Venous Disease

Peripheral Arterial Disease

Respiratory System Marked pulmonary insufficiency Restrictive Lung Disease or COPD with dyspnea at rest despite treatment Chronic supplemental O2 CO2 retention (pCO2 > 50 torr) Baseline pO2 < 50 torr FEV1 (< 50%) Gastrointestinal System Hepatic Portal hypertension and/or esophageal bleeding 6 mos. (Encephalopathy, Ascites, Jaundice with Total Bilirubin > 2) Restrictive Lung Disease or COPD (chronic bronchitis, emphysema, or asthma) with dyspnea which limits activities FEV1 (51%-65%)

Chronic hepatitis, cirrhosis, portal hypertension with moderate symptoms "compensated hepatic failure"

Chronic hepatitis or cirrhosis without portal hypertension Acute hepatitis without cirrhosis Chronic liver disease manifested on biopsy or persistently elevated bilirubin (>3 mg/dl) Diagnosis of ulcers treated with meds Chronic malabsorption syndrome Inflammatory bowel disease (IBD) on meds or h/o with complications and/or surgery Chronic pancreatitis w/o complications

Stomach / Intestine

Recent ulcers( 6 months ago) requiring blood transfusion

Ulcers requiring surgery or transfusion > 6 months ago

Pancreas

Acute or chronic pancreatitis with major complications (phlegmon, abscess, or pseudocyst)

Uncomplicated acute pancreatitis Chronic pancreatitis with minor complications (malabsorption, impaired glucose tolerance, or GI bleeding)

Cogent comorbid ailment

Renal System End-stage renal disease

Grade 3 Severe Decompensation

Creatinine > 3 mg% with multi-organ failure, shock, or sepsis Acute dialysis

Grade 2 Moderate Decompensation

Chronic Renal Insufficiency with creatinine >3 mg% Chronic dialysis

Grade 1 Mild Decompensation

Chronic Renal Insufficiency with creatinine 2-3 mg%.

Endocrine System Diabetes Mellitus

(Code the comorbid ailments with the (*) in both the Endocrine system and other organ systems if applicable) IDDM without complications AODM controlled by oral agents only Hospitalization 6 months for DKA Poorly controlled AODM with Diabetes causing end-organ failure oral agents retinopathy neuropathy nephropathy* coronary disease* peripheral arterial disease* Acute stroke with significant neurologic deficit Severe dementia requiring full support for activities of daily living Paraplegia or hemiplegia requiring full support for activities of daily living MS, Parkinsons, Myasthenia Gravis, or other chronic neuromuscular disorder and requiring full support for activities of daily living Recent suicidal attempt Active schizophrenia Old stroke with neurologic residual Moderate dementia (not completely self-sufficient, needs supervising) Paraplegia or hemiplegia requiring wheelchair, able to do some self care MS, Parkinsons, Myasthenia Gravis, or other chronic neuromuscular disorder, but able to do some self care Depression or bipolar disorder uncontrolled Schizophrenia controlled w/ meds Stroke with no residual Past or recent TIA Mild dementia (can take care of self) Paraplegia or hemiplegia, ambulatory and providing most of self care MS, Parkinsons, Myasthenia Gravis, or other chronic neuromuscular disorder, but ambulatory and providing most of self care Depression or bipolar disorder controlled w/ medication

Neurological System Stroke Dementia Paralysis Neuromuscular

Psychiatric

Rheumatologic

(Incl. Rheumatoid Arthritis, Systemic Lupus, Mixed Connective Tissue Disorder, Polymyositis, Rheumatic Polymyositis) Connective Tissue Disorder with Connective Tissue Disorder on Connective Tissue Disorder on secondary end-organ failure (renal, steroids or immunosuppressant NSAIDS or no treatment cardiac, CNS) medications

Immunological System (AIDS should not be considered a comorbidity for Kaposi's Sarcoma or Non-Hodgkin's Lymphoma) AIDS Fulminant AIDS w/KS, MAI, PCP (AIDS HIV+ with h/o defining illness. Asymptomatic HIV+ patient. defining illness) CD4+ < 200/L HIV+ w/o h/o AIDS defining illness. CD4+ > 200/L Malignancy Solid Tumor including melanoma (Excluding Cutaneous Basal Cell Ca., Cutaneous SCCA, Carcinoma in-situ, and Intraepithelial Neoplasm) Uncontrolled cancer Any controlled solid tumor without Any controlled solid tumor without Newly diagnosed but not yet treated documented metastases, but documented metastases, but initially Metastatic solid tumor initially diagnosed and treated diagnosed and treated > 5 years ago within the last 5 years Relapse Disease out of control Relapse 1st remission or new dx <1yr Chronic suppressive therapy 1st remission or new dx <1yr Chronic suppressive therapy H/o leukemia or myeloma with last Rx > 1 yr prior H/o lymphoma w/ last Rx >1 yr prior

Leukemia and Myeloma Lymphoma Substance Abuse Alcohol

(Must be accompanied by social, behavioral, or medical complications) Delirium tremens Active alcohol abuse with social, behavioral, or medical complications Acute Withdrawal Syndrome Active substance abuse with social, behavioral, or medical complications Morbid (i.e., BMI 38)

H/o alcohol abuse but not presently drinking H/o substance abuse but not presently using

Illicit Drugs

Body Weight Obesity

OVERALL COMORBIDITY SCORE (Circle one.)

0
None

1
Mild

2
Moderate

3
Severe

9
Unknown

Rev November 2003

Washington University School of Medicine

Clinical Outcomes Research Office