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.
(1) cardiac disease
(2) respiratory disease
(3) cerebrovascular disease
(4) peripheral vascular disease
NYHA Class 1
NYHA Class 2
NYHA Class 3
NYHA Class 4
severe but compensated
severe and disabling
peripheral vascular disease
symptomatic primary or metastatic disease present
extensive metastatic disease
• 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)
• 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
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.
severe and decompensated
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.
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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