Desai et al identified comorbid conditions that may pose increased risk for an elderly adult. These can help to identify a patient who may benefit from more aggressive management. The authors are from Yale University.
Patient selection: age >= 70 years
Outcome: 1 year mortality
Parameters:
(1) congestive heart failure, cardiomyopathy
(2) pneumonia
(3) chronic lung disease, including COPD
(4) cancer
(5) leukemia or malignant lymphoma
(6) major stroke (hemiplegia, etc)
(7) acute renal failure
(8) chronic renal failure
(9) diabetes mellitus with end-organ damage
|
Parameter
|
Finding
|
Points
|
|
congestive heart failure
|
absent
|
0
|
|
|
present
|
2
|
|
pneumonia
|
absent
|
0
|
|
|
present
|
1
|
|
chronic lung disease
|
absent
|
0
|
|
|
present
|
2
|
|
cancer
|
absent
|
0
|
|
|
localized
|
3
|
|
|
metastatic
|
3
|
|
leukemia or lymphoma
|
absent
|
0
|
|
|
present
|
6
|
|
major stroke
|
absent
|
0
|
|
|
present
|
2
|
|
acute renal failure
|
absent
|
0
|
|
|
present
|
5
|
|
chronic renal failure
|
absent
|
0
|
|
|
present
|
2
|
|
diabetes mellitus with end-organ damage
|
absent
|
0
|
|
|
present
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 24 or 27 (The paper gives 27, but the only way to achieve this is for localized cancer and metastatic cancer to both be counted).
• The higher the score the greater the risk for 1-year mortality.
|
Score
|
1-Year Mortality Rate
|
Risk Group
|
|
0
|
10%
|
low
|
|
1 or 2
|
32%
|
moderate
|
|
3 to 5
|
46%
|
high
|
|
>= 6
|
74%
|
very high
|
Performance:
• The area under the ROC curve for mortality was 0.77.
