Chaikof et al reported the Comorbidity Severity Score to evaluate a patient requiring repair of an abdominal aortic aneurysm. The authors are from an Ad Hoc Committee for Standardized Reporting of the Society of Vascular Surgery and American Association for Vascular Surgery.
Major components:
(1) cardiac status
(2) pulmonary status
(3) renal status
Minor components:
(1) hypertension
(2) age in years
|
Parameter |
Finding |
Points |
|
cardiac status |
asymptomatic and normal ECG |
0 |
|
|
asymptomatic but either remote AMI, occult MI by ECG, or fixed defect on cardiac scan |
1 |
|
|
stable angina, significant reversible perfusion defect on dipyridamole thallium scan, silent ischemia on Holter monitor, LVEF 25 to 45%, controlled ectopy or asymptomatic arrhythmia, history of CHF that is now well compensated |
2 |
|
|
unstable angina, LVEF less than 25%, AMI within past 6 months, poorly compensated or recurrent CHF, symptomatic or poorly controlled ectopy/arrhythmia |
3 |
|
pulmonary status |
asymptomatic with normal chest X-ray and pulmonary function tests (PFT) >= 80% of predicted |
0 |
|
|
asymptomatic or mild dyspnea on exertion, mild chronic parenchymal X-ray changes, PFT 65 to 79% of predicted |
1 |
|
|
between levels 1 and 3, PFT 33 to 64% of predicted |
2 |
|
|
vital capacity less than 1.85 L, FEV1 < 1.2 liters, FEV1 < 35% of predicted, maximal voluntary ventilation < 50% of predicted, PaCO2 > 45 mm Hg, supplemental oxygen needed, pulmonary hypertension |
3 |
|
renal status |
no known renal disease with normal serum creatinine |
0 |
|
|
serum creatinine up to 2.4 mg/dL |
1 |
|
|
serum creatinine 2.5 to 5.9 mg/dL |
2 |
|
|
serum creatinine > 6 mg/dL, on dialysis OR renal transplant |
3 |
|
hypertension |
none |
0 |
|
|
controlled with 1 drug |
1 |
|
|
controlled with 2 drugs |
2 |
|
|
uncontrolled or requires 3 or more drugs for control |
3 |
|
age in years |
< 55 years of age |
0 |
|
|
55 to 69 years of age |
1 |
|
|
70 to 79 years of age |
2 |
|
|
>= 80 years of age |
3 |
where:
• Control was defined as a diastolic blood pressure < 90 mm Hg.
• An elderly patient may show significant renal disease but only a mild elevation of the serum creatinine concentration.
• Several of the risk factors are from the risk factor classification of Rutherford et al in 06.22.20.
score =
= (4 * (points for cardiac status)) + (2 * (pulmonary status)) + (2 * (renal status)) + (points for hypertension status) + (points for age)
Interpretation:
• minimum score: 0
• maximum score: 30
• The higher the score the greater the mortality.
• A score > 8 was associated with increased mortality (> 10%).
• A score < 4 was associated with a low mortality rate.
Purpose: To evaluate a patient with an abdominal aortic aneurysm using the Comorbidity Severity Score of Chaikof et al.
Specialty: Cardiology
Objective: severity, prognosis, stage, complications, disease progression, complication detection, comorbid conditions
ICD-10: I71,
