Morales-Puerto et al reported criteria for multimorbidity for patients seen in the Emergency Department and admitted to the hospital. The authors are from Universidad de Malaga and affiliated institutions in Spain.
Patient selection: multimorbid patient in the Emergency Department or hospital
Criteria for multimorbidity was defined as >=1 of the following:
(1) extreme polypharmacy (>= 10 active prescription drugs)
(2) socio-familial risk (Gijon scale > 10)
(3) history of pressure ulcer Stage II or higher in the past 12 months
(4) malnutrition (body mass index < 18.5 kg per square meter)
(5) chronic enteral feeding
(6) >= 2 admissions in the past 12 months
(7) alcoholism
(8) >= 2 of the following categories
|
Category
|
Conditions
|
|
A
|
heart failure, NYHA class II, clinically stable
ischemic heart disease
|
|
B
|
vasculitis
systemic autoimmune disease
chronic kidney disease with eGFR < 60 mL per min
|
|
C
|
chronic respiratory disease, clinically stable
|
|
D
|
inflammatory bowel disease
chronic liver disease with evidence of hepatocellular failure
chronic liver disease with portal hypertension
|
|
E
|
cerebrovascular accident
neurological disease with permanent motor deficit that limits ADL
neurological disease with permanent cognitive impairment
|
|
F
|
peripheral arterial disease, symptomatic
diabetes with complications (proliferative retinopathy or neuropathy)
|
|
G
|
chronic anemia
hematologic neoplasm not responsive to curative treatment
|
|
H
|
chronic osteoarticular disease that limits ADL
history of osteoporotic hip fracture
|
where:
• Hepatocellular failure = INR > 1.7; serum albumin < 3.5 g/dL; bilirubin > 2 mg/dL
• Limited activities of daily living (ADL) is associated with a Barthel index < 60.
• Chronic respiratory disease should have MRC class 2 dyspnea, FEV1 < 70% of predicted or SaO2 <= 90%.
• Chronic anemia should be due to digestive losses or acquired hemopathy not responsive to curative therapy, with hemoglobin < 10 g/dL in 2 separate determinations > 3 months apart.
