Bernabeu-Wittel et al listed conditions used to define polypathology in a patient. The authors are from multiple hospitals in Spain.


A patient was defined as being a polypathology patients if s/he had 2 or more chronic disorders in the listed clinical categories.




chronic heart failure >= Stage II NYHA AND/OR

coronary artery disease


vasculitis or systemic autoimmune disorder AND/OR

chronic renal disease (elevated creatinine and/or proteinuria)


chronic lung disease with any of the following: dyspnea >= Stage 2 MRC, FEV1 < 65% of predicted, basal oxygen saturation <= 90%


chronic inflammatory bowel disease AND/OR

chronic liver disease with portal hypertension


stroke (cerebrovascular disease) AND/OR

a neurological disorder with permanent motor deficit causing severe deficit in activities of daily living AND/OR

a neurological disease with permanent moderate to severe cognitive impairment


symptomatic peripheral artery disease AND/OR

diabetes mellitus with neuropathy or proliferative retinopathy


chronic anemia AND/OR

solid organ active neoplasia AND/OR

hematologic active neoplasia


chronic osteoarticular disease with severe impairment in activities of daily living (ADL)



• Chronic renal failure: creatinine > 1.4 mg/dL in male, creatinine > 1.3 mg/dL in female for >= 3 months.

• Proteinuria >= 3 months: albumin to creatinine ratio > 300 mg/g, microalbuminuria > 3 mg/dL, albumin > 300 mg/day, or albuminuria > 200 micrograms per minute.

• Chronic anemia: hemoglobin < 10 g/dL for >= 3 months

• Most of the conditions were associated with significant impairment in activities of daily living (ADL).


Patients with polypathology tend:

(1) to be highly complex

(2) to have a high symptom load

(3) to be clinically vulnerable

(4) to be functionally impaired

(5) to be dependent on their caregivers

(6) to have limited social resources


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