Chandna et al used a severity score for comorbidity in patients with chronic renal failure. The authors are from Lister Hospital (Stevenage) and the University of Herfordshire in England.
Parameters:
(1) cardiac disease
(2) respiratory disease
(3) cerebrovascular disease
(4) peripheral vascular disease
(5) cirrhosis
(6) malignancy
|
Parameter |
Finding |
Point |
|
cardiac disease |
none |
0 |
|
|
NYHA Class 1 |
1 |
|
|
NYHA Class 2 |
2 |
|
|
NYHA Class 3 |
3 |
|
|
NYHA Class 4 |
4 |
|
respiratory disease |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe but compensated |
3 |
|
|
severe and disabling |
4 |
|
cerebrovascular disease |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe but compensated |
3 |
|
|
severe and disabling |
4 |
|
peripheral vascular disease |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe but compensated |
3 |
|
|
severe and disabling |
4 |
|
cirrhosis |
absent |
0 |
|
|
present |
4 |
|
malignancy |
none |
0 |
|
|
past history |
1 |
|
|
primary tumor |
2 |
|
|
symptomatic primary or metastatic disease present |
3 |
|
|
extensive metastatic disease |
4 |
where:
• The point assignment for cardiac disease and cirrhosis are specified in the paper. The point assignment for the other organs is my own.
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 24
• The higher the score the worse the prognosis.
• In the study a score of >= 5 was considered severe comorbidity; a score of 1-4 was considered mild to moderate comorbidity (see Figure 2, page 219).
• The number of organ groups scored 4 points is also important.
Modification of Cirrhosis : The only liver disease listed is cirrhosis, and no mention is made of gastrointestinal or nutritional disease. For the implementation I have used the following.
|
gastrointestinal, liver and nutritional disease |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe but compensated |
3 |
|
|
cirrhosis |
4 |
Modification of Renal Function : All of the patients in the study had renal failure, so no comorbid points were assigned for renal disease. For the implementation I have used the following.
|
renal disease |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe but compensated |
3 |
|
|
severe and decompensated |
4 |
This would raise the number of groups to 7 and maximum total score to 28. Since all patients had renal points >=3, severe comorbidity would now be >= (5 + 3) or >= 8.
Purpose: To evaluate the extent of comorbid conditions in a patient using a modification of the comorbidity severity score of Chandna et al.
Objective: severity, prognosis, stage, comorbid conditions
ICD-10: N18,
