Ifiudu et al used a numerical index to monitor comorbidity in patients undergoing maintenance hemodialysis. This can be useful for monitoring a patient's comorbidity over time. The authors are from the State University of New York Health Science Center at Brooklyn, New York.
NOTE: The authors originally evaluated 13 major organ systems. However, renal function was not included since all patients had renal failure. I have modified the index by adding a 14th item for genitourinary function.
Major organ systems:
(1) persistent angina or myocardial infarction (ischemic heart disease)
(2) other cardiovascular problems (hypertension, congestive heart failure, cardiomyopathy, other nonischemic disease)
(3) respiratory disease
(4) autonomic neuropathy (gastroparesis, obstipation, diarrhea, cystopathy, orthostatic hypotension, other)
(5) neurological problems, cerebrovascular accidents or residual stroke
(6) musculoskeletal disorders
(7) infections including AIDS (excluding vascular access site infection or peritonitis)
(8) liver, pancreas, gallbladder disease (hepatitis, hepatic insufficiency, enzymatic pancreatic insufficiency)
(9) hematologic problems (excluding anemia)
(10) spinal abnormalities, low back problems or arthritis
(11) vision impairment (decreased visual acuity to blindness)
(12) limb amputation (finger to lower extremity)
(13) mental or emotional illness (neurosis, depression, psychosis)
(14) genitourinary disease
where:
• Conditions like anemia, peritonitis, and vascular access site infection are not covered anywhere. I am not including these exclusions in the implementation.
• Limb amputation seems more a measure of peripheral vascular disease.
• The findings appear skewed towards diabetic comorbidities.
|
Comorbidity or Disability
|
Points
|
|
none
|
0
|
|
minor or mild
|
1
|
|
moderate
|
2
|
|
severe
|
3
|
total comorbidity index =
= SUM(points for all 14 organ systems)
Interpretation:
• minimum index: 0
• maximum index: 42
• The higher the index the greater the comorbidity.
• The number of moderate and severe disabilities should also be tallied.
