Description

Kaplan and Feinstein graded comorbid conditions based on the impact upon survival in patients with diabetes mellitus. The scale has been used to assess the impact of comorbidities in other conditions as well.


 

Types of comorbid conditions:

(1) cogent: (a) involve vital body systems, or (b) associated with anatomic, functional, or behavioral effects that might threaten life directly or make the patient susceptible to a fatal ailment.

(2) noncogent: (a) well-controlled ailments having no direct effects on vital organs, or (b) self-limited episodes occurring in the past without residua in the affected structures

Grade of Cogent Condition

Features

1

conditions involving slight decompensation of vital systems, or

chronic conditions posing a lesser threat than those in Grade 2

2

impairment without full decompensation of vital systems,

distant episodes of potentially life-threatening events, or

chronic conditions that are potentially threatening

3

recent full decompensation of vital structures

recent life-threatening events, or

chronic conditions that threaten life

 

Each condition affecting an organ system can then be characterized by these grades.

 

Examples of Cogent Grades

Hypertension

Cardiac

Renal

1

diastolic 90-114 mm Hg

atrial fibrillation

3+ or 4+ proteinuria

2

diastolic 115-129 mm Hg

CHF more than 6 months ago

hydronephrosis

3

malignant hypertension

myocardial infarction in last 6 months

uremia

from Table 2,pages 392-393 Kaplan and Feinstein

 

NOTE: A myocardial infarction more than 6 months ago is listed as a Grade 1 condition in the table. An old infarct could be classified several ways according to the criteria above (for example, as a Grade 2 if a life threatening event).

 

Comorbid Condition(s)

Patient Grade

Comborbidity

no cogent comorbid conditions, but may have 1 or more noncogent conditions

0

none

one or more Grade 1 cogent conditions

1

mild

one Grade 2 cogent condition

2

moderate

one Grade 3 cogent condition

3

severe

two or more Grade 2 cogent conditions

3

severe

 

where:

• The patient is assigned the grade of the most comorbid condition.

• There does not appear to be an exception for a number of Grade 1 conditions being raised to a Grade 2 status.

 

The patient grade was found to correlate with the morbidity rate seen at 5 years.

 

Patient Grade

5 Year Morbidity Rate in Diabetics

0

7%

1

28%

2

42%

3

69%

after Table page 396 Kaplan and Feinstein

 

Limitations:

• Unless a fairly complex and explicit table is constructed for each organ, I could see some intra-observer variation in classifying a patient.

• The system might work best in a basically healthy population. As the number of comorbid conditions increase, it would seem to lump everyone into Grade 3, which might be overly pessimistic for some of the patients.

 


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