Washington University Med School
Brookings

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 blood transfusion

Grade 2: Moderate Decompensation

Ulcers requiring surgery or transfusion > 6 months ago

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

1st 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

1st 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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