Comorbidity Calculator

Identify the important medical comorbidities and grade severity using the index. Overall Comorbidity Score is defined according to the highest ranked single ailment, except in the case where two or more Grade 2 ailments occur in different organ systems. In this situation, the overall comorbidity score should be designated Grade 3.
Organ System
Cogent Comorbid Ailment	Specific Comorbidities (by Grade)
Cardiovascular System
1. Myocardial Infarct	Grade 3: Severe Decompensation MI ≤ 6 months ago Grade 2: Moderate Decompensation MI > 6 months ago Grade 1: Mild Decompensation Old MI by ECG only, age undetermined
2. Angina / Coronary Artery Disease	Grade 3: Severe Decompensation Unstable angina Grade 2: Moderate Decompensation Chronic exertional angina Recent (≤ 6 months ago) Coronary Artery Bypass Graft (CABG) or Percutaneous Transluminal Coronary Angioplasty (PTCA) Recent (≤ 6 months ago) coronary stent Grade 1: Mild Decompensation ECG or stress test evidence or catheterization evidence of coronary disease without symptoms Angina pectoris not requiring hospitalization CABG or PTCA (> 6 months ago) Coronary stent (> 6 months ago)
3. Congestive Heart Failure (CHF)	Grade 3: Severe Decompensation Hospitalized for CHF within past 6 months Ejection fraction < 20% Grade 2: Moderate Decompensation Hospitalized for CHF > 6 months prior CHF with dyspnea which limits activities Grade 1: Mild Decompensation CHF with dyspnea which has responded to treatment Exertional dyspnea Paroxysmal Nocturnal Dyspnea (PND)
4. Arrhythmias	Grade 3: Severe Decompensation Ventricular arrhythmia ≤ 6 months ago Grade 2: Moderate Decompensation Ventricular arrhythmia > 6 months ago Chronic atrial fibrillation or flutter Pacemaker Grade 1: Mild Decompensation Sick Sinus Syndrome
5. Hypertension	Grade 3: Severe Decompensation DBP ≥ 130 mm Hg Severe malignant papilledema or other eye changes Encephalopathy Grade 2: Moderate Decompensation DBP 115-129 mm Hg DBP 90-114 mm Hg while taking antihypertensive medications Secondary cardiovascular symptoms: vertigo, epistaxis, headaches Grade 1: Mild Decompensation DBP 90-114 mm Hg while not taking antihypertensive medications DBP < 90 mm Hg while taking antihypertensive medications Hypertension, not otherwise specified
6. Venous Disease	Grade 3: Severe Decompensation Recent PE (≤ 6 months ago) Use of venous filter for PE's Grade 2: Moderate Decompensation DVT controlled with Coumadin or heparin Old PE > 6 months ago Grade 1: Mild Decompensation Old DVT no longer treated with Coumadin or Heparin
7. Peripheral Arterial Disease	Grade 3: Severe Decompensation Bypass or amputation for gangrene or arterial insufficiency < 6 months ago Untreated thoracic or abdominal aneurysm (≥ 6 cm) Grade 2: Moderate Decompensation Bypass or amputation for gangrene or arterial insufficiency > 6 months ago Chronic insufficiency Grade 1: Mild Decompensation Intermittent claudication Untreated thoracic or abdominal aneurysm (< 6 cm) s/p abdominal or thoracic aortic aneurysm repair
Respiratory System
8. Respiratory Disease	Grade 3: Severe Decompensation Marked pulmonary insufficiency Restrictive Lung Disease or COPD with dyspnea at rest despite treatment Chronic supplemental O₂ CO₂ retention (pCO₂ > 50 torr) Baseline pO₂ < 50 torr FEV1 (< 50%) Grade 2: Moderate Decompensation Restrictive Lung Disease or COPD (chronic bronchitis, emphysema, or asthma) with dyspnea which limits activities FEV1 (51%-65%) Grade 1: Mild Decompensation Restrictive Lung Disease or COPD (chronic bronchitis, emphysema, or asthma) with dyspnea which has responded to treatment FEV1 (66%-80%)
Gastrointestinal System
9. Hepatic	Grade 3: Severe Decompensation Portal hypertension and/or esophageal bleeding ≤ 6 months ago (Encephalopathy, Ascites, Jaundice with Total Bilirubin > 2) Grade 2: Moderate Decompensation Chronic hepatitis, cirrhosis, portal hypertension with moderate symptoms "compensated hepatic failure" Grade 1: Mild Decompensation Chronic hepatitis or cirrhosis without portal hypertension Acute hepatitis without cirrhosis Chronic liver disease manifested on biopsy or persistently elevated bilirubin (> 3 mg/dl)
10. Stomach / Intestine	Grade 3: Severe Decompensation Recent ulcers ≤ 6 months ago requiring ≥ 6 units of blood transfusion Grade 2: Moderate Decompensation Ulcers requiring surgery or transfusion of < 6 units of blood Grade 1: Mild Decompensation Diagnosis of ulcers treated with meds Chronic malabsorption syndrome Inflammatory bowel disease (IBD) on meds or h/o with complications and/or surgery
11. Pancreas	Grade 3: Severe Decompensation Acute or chronic pancreatitis with major complications (phlegmon, abscess, or pseudocyst) Grade 2: Moderate Decompensation Uncomplicated acute pancreatitis Chronic pancreatitis with minor complications (malabsorption, impaired glucose tolerance, or GI bleeding) Grade 1: Mild Decompensation Chronic pancreatitis w/o complications
Renal System
12. End-Stage Renal Disease	Grade 3: Severe Decompensation Creatinine > 3 mg% with multi-organ failure, shock, or sepsis Acute dialysis Grade 2: Moderate Decompensation Chronic Renal Insufficiency with creatinine > 3 mg% Chronic dialysis Grade 1: Mild Decompensation Chronic Renal Insufficiency with creatinine 2-3 mg%
Endocrine System	*Code the comorbid ailments with the () in both the Endocrine system and other organ systems if applicable.**
13. Diabetes Mellitus	Grade 3: Severe Decompensation Hospitalization ≤ 6 months ago for DKA Diabetes causing end-organ failure including retinopathy, neuropathy, nephropathy^, coronary disease^, or peripheral arterial disease^* Grade 2: Moderate Decompensation IDDM without complications Poorly controlled AODM Grade 1: Mild Decompensation AODM controlled by oral agents only
Neurological System
14. Stroke	Grade 3: Severe Decompensation Acute stroke with significant neurologic deficit Grade 2: Moderate Decompensation Old stroke with neurologic residual Grade 1: Mild Decompensation Stroke with no residual Past or recent TIA
15. Dementia	Grade 3: Severe Decompensation Severe dementia requiring full support for activities of daily living Grade 2: Moderate Decompensation Moderate dementia (not completely self-sufficient, needs supervising) Grade 1: Mild Decompensation Mild dementia (can take care of self)
16. Paralysis	Grade 3: Severe Decompensation Paraplegia or hemiplegia requiring full support for activities of daily living Grade 2: Moderate Decompensation Paraplegia or hemiplegia requiring wheelchair, able to do some self care Grade 1: Mild Decompensation Paraplegia or hemiplegia, ambulatory and providing most of self care
17. Neuromuscular	Grade 3: Severe Decompensation MS, Parkinson's, Myasthenia Gravis, or other chronic neuromuscular disorder and requiring full support for activities of daily living Grade 2: Moderate Decompensation MS, Parkinson's, Myasthenia Gravis, or other chronic neuromuscular disorder, but able to do some self care Grade 1: Mild Decompensation MS, Parkinson's, Myasthenia Gravis, or other chronic neuromuscular disorder, but ambulatory and providing most of self care
Psychiatric
18. Mental Illness	Grade 3: Severe Decompensation Recent suicidal attempt Active schizophrenia Grade 2: Moderate Decompensation Major depression or bipolar disorder uncontrolled Schizophrenia controlled w/ meds Grade 1: Mild Decompensation Major depression or bipolar disorder controlled w/ medication
Rheumatologic	Include Rheumatoid Arthritis, Systemic Lupus, Mixed Connective Tissue Disorder, Polymyositis, Rheumatic Polymyositis.
19. Rheumatologic Disease	Grade 3: Severe Decompensation Connective Tissue Disorder with secondary end-organ failure (renal, cardiac, CNS) Grade 2: Moderate Decompensation Connective Tissue Disorder on steroids or immunosuppressant medications Grade 1: Mild Decompensation Connective Tissue Disorder on NSAIDS or no treatment
Immunological System	AIDS should not be considered a comorbidity for Kaposi's Sarcoma or Non-Hodgkin's Lymphoma.
20. AIDS	Grade 3: Severe Decompensation Fulminant AIDS w/KS, MAI, PCP (AIDS defining illness) Grade 2: Moderate Decompensation HIV+ with h/o defining illness CD4⁺ < 200/μL Grade 1: Mild Decompensation Asymptomatic HIV+ patient HIV⁺ w/o h/o AIDS defining illness CD4⁺ > 200/μL
Malignancy	Excluding Cutaneous Basal Cell Ca., Cutaneous SCCA, Carcinoma in-situ, and Intraepithelial Neoplasm
21. Solid Tumor Including Melanoma	Grade 3: Severe Decompensation Uncontrolled cancer Newly diagnosed but not yet treated Metastatic solid tumor Grade 2: Moderate Decompensation Any controlled solid tumor without documented metastases, but initially diagnosed and treated within the last 5 years Grade 1: Mild Decompensation Any controlled solid tumor without documented metastases, but initially diagnosed and treated > 5 years ago
22. Leukemia and Myeloma	Grade 3: Severe Decompensation Relapse Disease out of control Grade 2: Moderate Decompensation 1^st remission or new dx < 1 yr Chronic suppressive therapy Grade 1: Mild Decompensation H/o leukemia or myeloma with last Rx > 1 yr prior
23. Lymphoma	Grade 3: Severe Decompensation Relapse Grade 2: Moderate Decompensation 1^st remission or new dx < 1 yr Chronic suppressive therapy Grade 1: Mild Decompensation H/o lymphoma w/ last Rx > 1 yr prior
Substance Abuse	Must be accompanied by social, behavioral, or medical complications
24. Alcohol	Grade 3: Severe Decompensation Delirium tremens Grade 2: Moderate Decompensation Active alcohol abuse with social, behavioral, or medical complications Grade 1: Mild Decompensation H/o alcohol abuse but not presently drinking
25. Illicit Drugs	Grade 3: Severe Decompensation Acute Withdrawal Syndrome Grade 2: Moderate Decompensation Active substance abuse with social, behavioral, or medical complications Grade 1: Mild Decompensation H/o substance abuse but not presently using
Body Weight
26. Obesity	Grade 3: Severe Decompensation (no relevant comorbidities at this grade) Grade 2: Moderate Decompensation Morbid (i.e., BMI ≥ 38) Grade 1: Mild Decompensation (no relevant comorbidities at this grade)
Overall Comorbidity Score
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