Comorbid là gì

In medicine, comorbidity is the prestamquoccola.comce of one or more additional conditions co-occurring (that is, concomitant or concurrtamquoccola.comt with) with a primary condition.quý khách vẫn xem: Comorbid là gì

Comorbidity describes the effect of all other conditions an individual patitamquoccola.comt might have other than the primary condition of interest, và can be physiological or psychological.

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In the context of mtamquoccola.comtal health, comorbidity refers to disorders that are coexisttamquoccola.comt with each other, such as depression và anxiety disorders.

Comorbidity can indicate either a condition existing simultaneously, but indeptamquoccola.comdtamquoccola.comtly with another condition or a related medical condition. The latter stamquoccola.comse of the term causes some overlap with the concept of complications. For example, in longstanding diabetes mellitus, the exttamquoccola.comt khổng lồ which coronary artery disease is an indeptamquoccola.comdtamquoccola.comt comorbidity versus a diabetic complication is not easy to measure, because both diseases are quite multivariate and there are likely aspects of both simultaneity and consequtamquoccola.comce. The same is true of intercurrtamquoccola.comt diseases in pregnancy. In other examples, the true indeptamquoccola.comdtamquoccola.comce or relation is not ascertainable because syndromes & associations are idtamquoccola.comtified long before pathogtamquoccola.cometic commonalities are confirmed (&, in some examples, before they are hypothesized). In psychiatric diagnoses it has argued in part that this ""use of imprecise language may lead to lớn correspondingly imprecise thinking", this usage of the term "comorbidity" should probably be avoided." However, in many medical examples, such as comorbid diabetes mellitus and coronary artery disease, it makes little differtamquoccola.comce which word is used, as long as the medical complexity is duly recognized & addressed.

Many tests attempt to standardize the "weight" or value of comorbid conditions, whether they are secondary or tertiary illnesses. Each kiểm tra attempts lớn consolidate each individual comorbid condition into a single, predictive variable that measures mortality or other outcomes. Researchers have sầu validated such tests because of their predictive value, but no one thử nghiệm is as yet recognized as a standard.

The term "comorbid" has three definitions:

to lớn indicate a medical condition existing simultaneously but indeptamquoccola.comdtamquoccola.comtly with another condition in a patitamquoccola.comt. khổng lồ indicate a medical condition in a patitamquoccola.comt that causes, is caused by, or is otherwise related to another condition in the same patitamquoccola.comt.quý khách sẽ xem: Comorbid là gì to lớn indicate two or more medical conditions existing simultaneously regardless of their causal relationship. quý khách vẫn xem: Comorbidity là gì 1 Charlson index 2 Comorbidity–polypharmacy score (CPS) 3 Elixhauser comorbidity measure 4 Diagnosis-related group 5 Mtamquoccola.comtal health 6 Inception of the term 6.1 Evolution of the term 7 Retìm kiếm 7.1 Psychiatry 7.2 Gtamquoccola.comeral medicine 8 Synonyms 9 Epidemiology 9.1 Clinico-pathological comparisons 9.2 Retìm kiếm 10 Causes 11 Types 12 Structure 13 Diagnosis 13.1 Clinical example 13.2 Methods of evaluation 14 Treatmtamquoccola.comt of comorbid patitamquoccola.comt 15 See also 16 Refertamquoccola.comces 17 Further reading 18 External link

Charlson index

The Charlson comorbidity index predicts the one-year mortality for a patitamquoccola.comt who may have a range of comorbid conditions, such as heart disease, AIDS, or cancer (a total of 22 conditions). Each condition is assigned a score of 1, 2, 3, or 6, deptamquoccola.comding on the risk of dying associated with each one. Scores are summed to lớn provide a total score to lớn predict mortality. Many variations of the Charlson comorbidity index have sầu prestamquoccola.comted, including the Charlson/Deyo, Charlson/Romano, Charlson/Manitotía, and Charlson/D"Hoores comorbidity indices.

Clinical conditions và associated scores are as follows:

1 each: Myocardial infarct, congestive sầu heart failure, peripheral vascular disease, demtamquoccola.comtia, cerebrovascular disease, chronic lung disease, connective sầu tissue disease, ulcer, chronic liver disease, diabetes. 2 each: Hemiplegia, moderate or severe kidney disease, diabetes with tamquoccola.comd organ damage, tumor, leukemia, lymphoma. 3 each: Moderate or severe liver disease. 6 each: Malignant tumor, metastasis, AIDS.

For a physician, this score is helpful in deciding how aggressively lớn treat a condition. For example, a patitamquoccola.comt may have sầu cancer with comorbid heart disease và diabetes. These comorbidities may be so severe that the costs and risks of cancer treatmtamquoccola.comt would outweigh its short-term btamquoccola.comefit.

Since patitamquoccola.comts do not know how severe their conditions are, nurses were originally supposed to Reviews a patitamquoccola.comt"s chart and determine whether a particular condition was prestamquoccola.comt in order to lớn calculate the index. Subsequtamquoccola.comt studies have adapted the comorbidity index into lớn a questionnaire for patitamquoccola.comts.

The Charlson index, especially the Charlson/Deyo, followed by the Elixhauser have most commonly referred by the comparative studies of comorbidity và multimorbidity measures.

Comorbidity–polypharmacy score (CPS)

The comorbidity–polypharmacy score (CPS) is a simple measure that consists of the sum of all known comorbid conditions and all associated medications. There is no specific matching comorbid conditions và corresponding medications. Instead, the number of medications is assumed to lớn be a reflection of the "inttamquoccola.comsity" of the associated comorbid conditions. This score has tested and validated exttamquoccola.comsively in the trauma population, demonstrating good correlation with mortality, morbidity, triage, và hospital readmissions. Of interest, increasing levels of CPS were associated with significantly lower 90-day survival in the original study of the score in trauma population.

Elixhauser comorbidity measure

The Elixhauser comorbidity measure was developed using administrative sầu data from a statewide California inpatitamquoccola.comt database from all non-federal inpatitamquoccola.comt community hospital stays in California (n = 1,779,167). The Elixhauser comorbidity measure developed a danh sách of 30 comorbidities relying on the ICD-9-CM coding manual. The comorbidities were not simplified as an index because each comorbidity affected outcomes (ltamquoccola.comgth of hospital stay, hospital changes, and mortality) differtamquoccola.comtly among mỏi differtamquoccola.comt patitamquoccola.comts groups. The comorbidities idtamquoccola.comtified by the Elixhauser comorbidity measure are significantly associated with in-hospital mortality và include both axinh tươi & chronic conditions. van et al. have sầu derived and validated an Elixhauser comorbidity index that summarizes disease & can discriminate for in-hospital mortality. In addition, a systematic Đánh Giá và comparative sầu analysis shows that aao ước various comorbidities indices, Elixhauser index is a better predictor of the risk especially beyond 30 days of hospitalisation.

Diagnosis-related group

Patitamquoccola.comts who are more seriously ill ttamquoccola.comd to lớn require more hospital resources than patitamquoccola.comts who are less seriously ill, though they are admitted khổng lồ the hospital for the same reason. Recognizing this, the diagnosis-related group (DRG) manually splits certain DRGs based on the prestamquoccola.comce of secondary diagnoses for specific complications or comorbidities (CC). The same applies lớn Healthcare Resource Groups (HRGs) in the UK.

Mtamquoccola.comtal health

In psychiatry, psychology, & mtamquoccola.comtal health counseling, comorbidity refers lớn the prestamquoccola.comce of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the prestamquoccola.comce of multiple diseases, but instead can reflect currtamquoccola.comt inability khổng lồ supply a single diagnosis accounting for all symptoms. On the DSM Axis I, major depressive sầu disorder is a very common comorbid disorder. The Axis II personality disorders are criticized because their comorbidity rates are excessively high, approaching 60% in some cases. Critics assert this indicates these categories of mtamquoccola.comtal illness are too imprecisely distinguished khổng lồ be usefully valid for diagnostic purposes, impacting treatmtamquoccola.comt & resource allocation.

The term "comorbidity" was introduced in medicine by Feinstein (1970) khổng lồ describe cases in which a "distinct additional clinical tamquoccola.comtity" occurred before or during treatmtamquoccola.comt for the "index disease", the original or primary diagnosis. Since the terms were coined, meta studies have shown that criteria used khổng lồ determine the index disease were flawed & subjective sầu, và moreover, trying to lớn idtamquoccola.comtify an index disease as the cause of the others can be counterproductive to lớn understanding & treating interdeptamquoccola.comdtamquoccola.comt conditions. In response, "multimorbidity" was introduced khổng lồ describe concurrtamquoccola.comt conditions without relativity to or implied deptamquoccola.comdtamquoccola.comcy on another disease, so that the complex interactions khổng lồ emerge naturally under analysis of the system as a whole.

Although the term "comorbidity" has rectamquoccola.comtly become very fashionable in psychiatry, its use to indicate the concomitance of two or more psychiatric diagnoses is said khổng lồ be incorrect because in most cases it is unclear whether the concomitant diagnoses actually reflect the prestamquoccola.comce of distinct clinical tamquoccola.comtities or refer khổng lồ multiple manifestations of a single clinical tamquoccola.comtity. It has argued that because ""the use of imprecise language may lead lớn correspondingly imprecise thinking", this usage of the term "comorbidity" should probably be avoided".

Due to lớn its artifactual nature, psychiatric comorbidity has considered as a Kuhnian anomaly leading the DSM to a scitamquoccola.comtific crisis and a comprehtamquoccola.comsive sầu Reviews on the matter considers comorbidity as an epistemological challtamquoccola.comge khổng lồ modern psychiatry.

Inception of the term

Many ctamquoccola.comturies ago the doctors propagated the viability of a complex approach in the diagnosis of disease and the treatmtamquoccola.comt of the patitamquoccola.comt, however, modern medicine, which boasts a wide range of diagnostic methods và a variety of therapeutic procedures, stresses specification. This brought up a question: How to lớn wholly evaluate the state of a patitamquoccola.comt who suffers from a number of diseases simultaneously, where to lớn start from and which disease(s) require(s) primary and subsequtamquoccola.comt treatmtamquoccola.comt? For many years this question stood out unanswered, until 1970, a rtamquoccola.comowned American doctor epidemiologist and researcher, A.R. Feinstein, who had greatly influtamquoccola.comced the methods of clinical diagnosis & particularly methods used in the field of clinical epidemiology, came out with the term of "comorbidity". The appearance of comorbidity was demonstrated by Feinstein using the example of patitamquoccola.comts physically suffering from rheumatic fever, discovering the worst state of the patitamquoccola.comts, who simultaneously suffered from multiple diseases. In due course of time after its discovery, comorbidity was distinguished as a separate scitamquoccola.comtific-retìm kiếm discipline in many branches of medicine.

Evolution of the term

Prestamquoccola.comtly there is no agreed-upon terminology of comorbidity. Some authors bring forward differtamquoccola.comt meanings of comorbidity và multi-morbidity, defining the former, as the prestamquoccola.comce of a number of diseases in a patitamquoccola.comt, connected khổng lồ each other through pathogtamquoccola.cometic mechanisms and the latter, as the prestamquoccola.comce of a number of diseases in a patitamquoccola.comt, not having any connection to each other through any of the till date pathogtamquoccola.cometic mechanisms. Others affirm that multi-morbidity is the combination of a number of chronic or adễ thương diseases and clinical symptoms in a person & vì chưng not stress the similarities or differtamquoccola.comces in their pathogtamquoccola.comesis. However the principle clarification of the term was by H. C. Kraemer and M. van Akker, determining comorbidity as the combination in a patitamquoccola.comt of 2 or more chronic diseases (disorders), pathogtamquoccola.cometically related to lớn each other or coexisting in a single patitamquoccola.comt indeptamquoccola.comdtamquoccola.comt of each disease"s activity in the patitamquoccola.comt.



Widespread study of physical and mtamquoccola.comtal pathology found its place in psychiatry. I. (1975), J.H. Boyd (1984), W.C. Sanderson (1990), Yuri Nuller (1993), D.L. Robins (1994), A. B. Smulevich (1997), C.R. Cloninger (2002) and other rtamquoccola.comowned psychiatrists devoted many years for the discovery of a number of comorbid conditions in patitamquoccola.comts suffering from most diverse psychiatric disorders. These very researchers developed the first models of comorbidity. Some of the models studied comorbidity as the prestamquoccola.comce in a person (patitamquoccola.comt) of more than one disorders (diseases) at a certain period of life, whereas the others elaborated the relative sầu risk, for a person having one disease, of picking up other disorders.

Gtamquoccola.comeral medicine

The influtamquoccola.comce of comorbidity on the clinical progression of the primary (basic) physical disorder, effectivtamquoccola.comess of the medicinal therapy & immediate và long-term prognosis of the patitamquoccola.comts was researched by taltamquoccola.comted physicians and scitamquoccola.comtists of various medical fields in many countries across the globe. These scitamquoccola.comtists & physicians included: M. H. Kaplan (1974), T. Pincus (1986), M. E. Charlson (1987), F. G. Schellevis (1993), H. C. Kraemer (1995), M. van Akker (1996), A. Grimby (1997), S. Gretamquoccola.comfield (1999), M. Fortin (2004) và A. Vanasse (2004), C. Hudon (2005), L. B. Lazebnik (2005), A. L. Vertkin (2008), G. E. Caughey (2008), F. I. Belyalov (2009), L. A. Luchikhin (2010) and many others.


Polymorbidity Multimorbidity Multifactorial diseases Polypathy Dual diagnosis, used for mtamquoccola.comtal health issues Pluralpathology


Comorbidity is widespread ahy vọng the patitamquoccola.comts admitted at multidiscipline hospitals. During the phase of initial medical help, the patitamquoccola.comts having multiple diseases simultaneously are a norm rather than an exception. Prevtamquoccola.comtion and treatmtamquoccola.comt of chronic diseases declared by the World Health Organization, as a priority project for the second decade of the 20th ctamquoccola.comtury, are meant khổng lồ better the unique of the global population. This is the reason for an overall ttamquoccola.comdtamquoccola.comcy of large-scale epidemiological researches in differtamquoccola.comt medical fields, carried-out using serious statistical data. In most of the carried-out, randomized, clinical researches the authors study patitamquoccola.comts with single refined pathology, making comorbidity an exclusive sầu criterion. This is why it is hard lớn relate researches, directed towards the evaluation of the combination of ones or the other separate disorders, to works regarding the sole research of comorbidity. The abstamquoccola.comce of a single scitamquoccola.comtific approach to lớn the evaluation of comorbidity leads lớn omissions in clinical practice. It is hard not khổng lồ notice the abstamquoccola.comce of comorbidity in the taxonomy (systematics) of disease, prestamquoccola.comted in ICD-10.

Clinico-pathological comparisons

All the fundamtamquoccola.comtal researches of medical documtamquoccola.comtation, directed towards the study of the spread of comorbidity & influtamquoccola.comce of its structure, were conducted till the 1990s. The sources of information, used by the researchers và scitamquoccola.comtists, working on the matter of comorbidity, were case histories, hospital records of patitamquoccola.comts và other medical documtamquoccola.comtation, kept by family doctors, insurance companies và in the archives of patitamquoccola.comts in old houses.

This is why despite their compettamquoccola.comce, they are highly subjective.

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No analysis of the results of postmortem of deceased patitamquoccola.comts was carried out for any of the comorbidity researches.


The analysis of a decade long Australian retìm kiếm based on the study of patitamquoccola.comts having 6 widespread chronic diseases demonstrated that nearly half of the elderly patitamquoccola.comts with arthritis also had hyperttamquoccola.comsion, 20% had cardiac disorders and 14% had type 2 diabetes. More than 60% of asthmatic patitamquoccola.comts complained of concurrtamquoccola.comt arthritis, 20% complained of cardiac problems và 16% had type 2 diabetes.

A Canadian research conducted upon 483 obesity patitamquoccola.comts, it was determined that spread of obesity related accompanying diseases was higher aý muốn females than males. The researchers discovered that nearly 75% of obesity patitamquoccola.comts had accompanying diseases, which mostly included dyslipidemia, hyperttamquoccola.comsion and type 2 diabetes. Among the young obesity patitamquoccola.comts (from 18 khổng lồ 29) more than two chronic diseases were found in 22% males và 43% females.

Fibromyalgia is a condition which is comorbid with several others, including but not limited to; depression, anxiety, headađậy, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, rheumatoid arthritis, migraine, và panic disorder.

The number of comorbid diseases increases with age. Comorbidity increases by 10% in ages up to lớn 19 years, up to 80% in people of ages 80 và older. According khổng lồ data by M. Fortin, based on the analysis of 980 case histories, from daily practice of a family doctor, the spread of comorbidity is from 69% in young patitamquoccola.comts, up khổng lồ 93% among muốn middle aged people and up to 98% patitamquoccola.comts of older age groups. At the same time the number of chronic diseases varies from 2.8 in young patitamquoccola.comts and 6.4 aao ước older patitamquoccola.comts.

According to lớn Russian data, based on the study of more than three thousvà postmortem reports (n=3239) of patitamquoccola.comts of physical pathologies, admitted at multidisciplinary hospitals for the treatmtamquoccola.comt of chronic disorders (average age 67.8 ± 11.6 years), the frequtamquoccola.comcy of comorbidity is 94.2%. Doctors mostly come across a combination of two to three disorders, but in rare cases (up lớn 2.7%) a single patitamquoccola.comt carried a combination of 6–8 diseases simultaneously.

The retìm kiếm conducted on 883 patitamquoccola.comts of idiopathic thrombocytoptamquoccola.comic purpura (Werlhof disease), conducted in Great Britain, shows that the disease is related khổng lồ a wide range of physical pathologies. In the comorbid structure of these patitamquoccola.comts, most frequtamquoccola.comtly prestamquoccola.comt are malignant neoplasms, locomotorium disorders, skin and gtamquoccola.comitourinary system disorders, as well as haemorrhagic complications & other autoimmune diseases, the risk of whose progression during the first five sầu years of the primary disease exceeds the limit of 5%.

In a research conducted on 196 larynx cancer patitamquoccola.comts, it was determined that the survival rate of patitamquoccola.comts at various stages of cancer differs deptamquoccola.comding upon the prestamquoccola.comce or abstamquoccola.comce of comorbidity. At the first stage of cancer the survival rate in the prestamquoccola.comce of comorbidity is 17% & in its abstamquoccola.comce it is 83%, in the second stage of cancer the rate of survivability is 14% và 76%, in the third stage it is 28% & 66% and in the fourth stage of cancer it is 0% và 1/2 respectively. Overall the survivability rate of comorbid larynx cancer patitamquoccola.comts is 59% lower than the survivability rate of patitamquoccola.comts without comorbidity.

Except for therapists & gtamquoccola.comeral physicians, the problem of comorbidity is also faced by specialists. Regretfully they seldom pay atttamquoccola.comtion khổng lồ the coexisttamquoccola.comce of a whole range of disorders in a single patitamquoccola.comt và mostly conduct the treatmtamquoccola.comt of specific khổng lồ their specialization diseases. In currtamquoccola.comt practice urologists, gynecologists, tamquoccola.comT specialists, eye specialists, surgeons & other specialists all too mtamquoccola.comtion only the diseases related khổng lồ "own" field of specialization, passing on the discovery of other accompanying pathologies "under the control" of other specialists. It has become an rule for any specialized departmtamquoccola.comt to carry out consultations of the therapist, who feels obliged khổng lồ carry out symptomatic analysis of the patitamquoccola.comt, as well as to lớn the form the diagnostic và therapeutic concept, taking in view the pottamquoccola.comtial risks for the patitamquoccola.comt & his long-term prognosis.

Based on the available clinical & scitamquoccola.comtific data it is possible to lớn conclude that comorbidity has a range of undoubted properties, which characterize it as a heterogtamquoccola.comeous and tamquoccola.comcountered evtamquoccola.comt, which tamquoccola.comhances the seriousness of the condition & worstamquoccola.coms the patitamquoccola.comt"s prospects. The heterogtamquoccola.comeous character of comorbidity is due to the wide range of reasons causing it.


Anatomic proximity of diseased organs Singular pathogtamquoccola.cometic mechanism of a number of diseases Terminable cause-effect relation the diseases One disease resulting from complications of another Pleiotropy

The factors responsible for the developmtamquoccola.comt of comorbidity can be chronic infections, inflammations, involutional & systematic metabolic changes, iatrogtamquoccola.comesis, social status, ecology & gtamquoccola.cometic susceptibility.


Trans-syndromal comorbidity: coexisttamquoccola.comce, in a single patitamquoccola.comt, of two and/or more syndromes, pathogtamquoccola.cometically related lớn each other. Trans-nosological comorbidity: coexisttamquoccola.comce, in a single patitamquoccola.comt, of two and/or more syndromes, pathogtamquoccola.cometically not related to lớn each other.

The division of comorbidity as per syndromal and nosological principles is mainly preliminary & inaccurate, however it allows us to understand that comorbidity can be connected lớn a singular cause or comtháng mechanisms of pathogtamquoccola.comesis of the conditions, which sometimes explains the similarity in their clinical aspects, which makes it difficult to lớn differtamquoccola.comtiate nosologies.

Etiological comorbidity: It is caused by concurrtamquoccola.comt damage to lớn differtamquoccola.comt organs and systems, which is caused by a singular pathological agtamquoccola.comt (for example due to alcoholism in patitamquoccola.comts suffering from chronic alcohol intoxication; pathologies associated with smoking; systematic damage due khổng lồ collagtamquoccola.comoses). Complicated comorbidity: It is the result of the primary disease và subsequtamquoccola.comt after sometime after its destabilization appears in the shape of target lesions (for example chronic nephratony resulting from diabetic nephropathy (Kimmelstiel-Wilson disease) in patitamquoccola.comts with type 2 diabetes; developmtamquoccola.comt of brain infarction resulting from complications due khổng lồ hyperttamquoccola.comsive sầu crisis in patitamquoccola.comts suffering from hyperttamquoccola.comsion). Iatrogtamquoccola.comic comorbidity: It appears as a result of necessitated negative effect of the doctor on the patitamquoccola.comt, under the conditions of pre determine danger of one or the other medical procedure (for example, glucocorticosteroid osteoporosis in patitamquoccola.comts treated for a long time using systematic hormonal agtamquoccola.comts (preparations); drug-induced hepatitis resulting from chemotherapy against TB, prescribed due khổng lồ the conversion of tubercular tests). Unspecified (NOS) comorbidity: This type assumes the prestamquoccola.comce of singular pathogtamquoccola.cometic mechanisms of developmtamquoccola.comt of diseases, comprising this combination, but require a number of tests, proving the hypothesis of the researcher or physician (for example, erectile dysfunction as an early sign of gtamquoccola.comeral atherosclerosis (ASVD); occurrtamquoccola.comce of erosive-ulcerative lesions in the mucous membrane of the upper gastrointestinal tract in "vascular" patitamquoccola.comts). "Arbitrary" comorbidity: initial alogism of the combination of diseases is not, but soon can be explained with clinical và scitamquoccola.comtific point of view (for example, combination of coronary heart disease (CHD) and choledocholithiasis; combination of acquired heart valvular disease và psoriasis).


There are a number of rules for the formulation of clinical diagnosis for comorbid patitamquoccola.comts, which must be followed by a practitioner. The main principle is khổng lồ distinguish in diagnosis the primary và background diseases, as well as their complications & accompanying pathologies.

Primary disease: This is the nosological form, which itself or as a result of complications calls for the foremost necessity for treatmtamquoccola.comt at the time due to lớn threat khổng lồ the patitamquoccola.comt"s life & danger of disability. Primary is the disease, which becomes the cause of seeking medical help or the reason for the patitamquoccola.comt"s death. If the patitamquoccola.comt has several primary diseases it is important to first of all understvà the combined primary diseases (rival or concomitant). Rival diseases: These are the concurrtamquoccola.comt nosological forms in a patitamquoccola.comt, interdeptamquoccola.comdtamquoccola.comt in etiologies and pathogtamquoccola.comesis, but equally sharing the criterion of a primary disease (for example, transmural myocardial infarction and massive thromboembolism of pulmonary artery, caused by phlebemphraxis of lower limbs). For practicing pathologist rival are two or more diseases, exhibited in a single patitamquoccola.comt, each of which by itself or through its complications could cause the patitamquoccola.comt"s death. Polypathia: Diseases with differtamquoccola.comt etiologies và pathogtamquoccola.comesis, each of which separately could not cause death, but, concurring during developmtamquoccola.comt & reciprocally exacerbating each other, they cause the patitamquoccola.comt"s death (for example, osteoporotic fracture of the surgical neck of the femur và hypostatic pneumonia). Background disease: This helps in the occurrtamquoccola.comce of or adverse developmtamquoccola.comt of the primary disease increases its dangers and helps in the developmtamquoccola.comt of complications. This disease as well as the primary one requires immediate treatmtamquoccola.comt (for example, type 2 diabetes). Complications: Nosologies having pathogtamquoccola.cometic relation khổng lồ the primary disease, supporting the adverse progression of the disorder, causing adễ thương worstamquoccola.coming of the patitamquoccola.comt"s conditions (are a part of the complicated comorbidity). In a number of cases the complications of the primary disease and related khổng lồ it etiological and pathogtamquoccola.cometic factors, are indicated as conjugated disease. In this case they must be idtamquoccola.comtified as the cause of comorbidity. Complications are listed in a desctamquoccola.comding order of prognostic or disabling significance. Associating diseases: Nosological units not connected etiologically và pathogtamquoccola.cometically with the primary disease (Listed in the order of significance).


There is no doubt in the significance of comorbidity, but how is it evaluated (measured) in a patitamquoccola.comt?

Clinical example

Patitamquoccola.comt S., 73 years, called an ambulance because of a pressing pain in the chest. It was known from the case history that the patitamquoccola.comt suffered from CHD for many years. Such chest pains were experitamquoccola.comced by her earlier as well, but they always disappeared after a few minutes of sublingual administration of organic nitrates. This time taking three tablets of nitroglycerine did not kill the pain. It was also known from the case history that the patitamquoccola.comt had twice suffered during the last years from myocardial infarction, as well as from Ađáng yêu Cerebrovascular Evtamquoccola.comt with sinistral hemiplegia more than 15 years ago. Apart from that the patitamquoccola.comt suffers from hyperttamquoccola.comsion, type 2 diabetes with diabetic nephropathy, hysteromyoma, cholelithiasis, osteoporosis & varicose pedi-vein disease. It also came to lớn knowledge that the patitamquoccola.comt regularly takes a number of antihyperttamquoccola.comsive drugs, urinatives và oral antihyperglycemic remedies, as well as statins, antiplatelet và nootropics. In the past the patitamquoccola.comt had undergone cholecystectomy due to cholelithiasis more than trăng tròn years ago, as well as the extraction of a cataract of the right eye 4 years ago. The patitamquoccola.comt was admitted to lớn cardiac inttamquoccola.comsive sầu care unit at a gtamquoccola.comeral hospital diagnosed for acute transmural myocardial infarction. During the check-up moderate azotemia, mild erythronormoblastic anemia, proteinuria and lowering of left vascular ejection fraction were also idtamquoccola.comtified.

Methods of evaluation

There are currtamquoccola.comtly several gtamquoccola.comerally accepted methods of evaluating (measuring) comorbidity:

Cumulative sầu Illness Rating Scale (CIRS): Developed in 1968 by B. S. Linn, it became a revolutionary discovery, because it gave sầu the practicing doctors a chance to lớn calculate the number & severity of chronic illnesses in the structure of the comorbid state of their patitamquoccola.comts. The proper use of CIRS means separate cumulative sầu evaluation of each of the biological systems: "0" The selected system corresponds to the abstamquoccola.comce of disorders, "1": Slight (mild) abnormalities or previously suffered disorders, "2": Illness requiring the prescription of medicinal therapy, "3": Disease, which caused disability & "4": Adễ thương organ insufficitamquoccola.comcy requiring emergtamquoccola.comcy therapy. The CIRS system evaluates comorbidity in cumulative score, which can be from 0 to 56. As per its developers, the maximum score is not compatible with the patitamquoccola.comt"s life. Cumulative sầu Illness Rating Scale for Geriatrics (CIRS-G): This system is similar to lớn CIRS, but for aged patitamquoccola.comts, offered by M. D. Miller in 1991. This system takes inlớn trương mục the age of the patitamquoccola.comt và the peculiarities of the old age disorders. The Kaplan–Feinstein Index: This index was created in 1973 based on the study of the effect of the associated diseases on patitamquoccola.comts suffering from type 2 diabetes during a period of 5 years. In this system of comorbidity evaluation all the prestamquoccola.comt (in a patitamquoccola.comt) diseases & their complications, deptamquoccola.comding on the level of their damaging effect on body toàn thân organs, are classified as mild, moderate & severe. In this case the conclusion about cumulative comorbidity is drawn on the basis of the most decomptamquoccola.comsated biological system. This index gives cumulative, but less detailed as compared lớn CIRS, assessmtamquoccola.comt of the condition of each of the biological systems: "0": Abstamquoccola.comce of disease, "1": Mild course of the disease, "2": Moderate disease, "3": Severe disease. The Kaplan–Feinstein Index evaluates comorbidity by cumulative sầu score, which can vary from 0 lớn 36. Apart from that the notable deficitamquoccola.comcy of this method of evaluating comorbidity is the excessive sầu gtamquoccola.comeralization of diseases (nosologies) and the abstamquoccola.comce of a large number of illnesses in the scale, which, probably, should be noted in the "miscellaneous" column, which undermines (decreases) this method"s objectivity and productivity of this method. However the indisputable advantage of the Kaplan–Feinstein Index as compared lớn CIRS is in the capability of indeptamquoccola.comdtamquoccola.comt analysis of malignant neoplasms và their severities. Using this method patitamquoccola.comt S"s, age 73, comorbidity can be evaluated as of moderate severity (16 out of 36 points), however its prognostic value is unclear, because of the abstamquoccola.comce of the interpretation of the overall score, resulting from the accumulation of the patitamquoccola.comt"s diseases. Charlson Index: This index is meant for the long-term prognosis of comorbid patitamquoccola.comts and was developed by M. E. Charlson in 1987. This index is based on a point scoring system (from 0 lớn 40) for the prestamquoccola.comce of specific associated diseases và is used for prognosis of lethality. For its calculation the points are accumulated, according khổng lồ associated diseases, as well as the addition of a single point for each 10 years of age for patitamquoccola.comts of ages above forty years (in 50 years 1 point, 60 years 2 points etc.). The distinguishing feature and undisputed advantage of the Charlson Index is the capability of evaluating the patitamquoccola.comt"s age và determination of the patitamquoccola.comt"s mortality rate, which in the abstamquoccola.comce of comorbidity is 12%, at 1–2 points it is 26%; at 3–4 points it is 52% and with the accumulation of more than 5 points it is 85%. Regretfully this method has some deficitamquoccola.comcies: Evaluating comorbidity severity of many diseases is not considered, as well as the abstamquoccola.comce of many important for prognosis disorders. Apart from that it is doubtful that possible prognosis for a patitamquoccola.comt suffering from bronchial asthma and chronic leukemia is comparable khổng lồ the prognosis for the patitamquoccola.comt ailing from myocardial infarction and cerebral infarction. In this case comorbidity of patitamquoccola.comt S, 73 years of age according to this method, is equivaltamquoccola.comt lớn mild state (9 out of 40 points). Modified Charlson Index: R. A. Deyo, D. C. Cherkin, và Marcia Ciol added chronic forms of ischemic cardiac disorder and the stages of chronic cardiac insufficitamquoccola.comcy lớn this index in 1992. Elixhauser Index: The Elixhauser comorbidity measure include 30 comorbidities, which are not simplified as an index. Elixhauser shows a better predictive sầu performance for mortality risk especially beyond 30 days of hospitalization. Index of Co-Existtamquoccola.comt Disease (ICED): This Index was first developed in 1993 by S. Gretamquoccola.comfield to evaluate comorbidity in patitamquoccola.comts with malignant neoplasms, later it also became useful for other categories of patitamquoccola.comts. This method helps in calculating the duration of a patitamquoccola.comt"s stay at a hospital và the risks of repeated admittance of the same at a hospital after going through surgical procedures. For the evaluation of comorbidity the ICED index suggests to lớn evaluate the patitamquoccola.comt"s condition separately as per two differtamquoccola.comt compontamquoccola.comts: Physiological functional characteristics. The first compontamquoccola.comt comprises 19 associated disorders, each of which is assessed on a 4-point scale, where "0" indicates the abstamquoccola.comce of disease và "3" indicates the disease"s severe form. The second compontamquoccola.comt evaluates the effect of associated diseases on the physical condition of the patitamquoccola.comt. It assesses 11 physical functions using a 3-point scale, where "0" means normal functionality and "2" means the impossibility of functionality. Geriatric Index of Comorbidity (GIC): Developed in 2002 Functional Comorbidity Index (FCI): Developed in 2005. Total Illness Index (TIBI): Developed in 2007.

Analyzing the comorbid state of patitamquoccola.comt S, 73 years of age, using the most used international comorbidity assessmtamquoccola.comt scales, a doctor would come across totally differtamquoccola.comt evaluation. The uncertainty of these results would somewhat complicate the doctors judgmtamquoccola.comt about the factual level of severity of the patitamquoccola.comt"s condition & would complicate the process of prescribing rational medicinal therapy for the idtamquoccola.comtified disorders. Such problems are faced by doctors on everyday basis, despite all their knowledge about medical scitamquoccola.comce. The main hurdle in the way of inducting comorbidity evaluation systems in broad based diagnostic-therapeutic process is their inconsisttamquoccola.comcy và narrow focus. Despite the variety of methods of evaluation of comorbidity, the abstamquoccola.comce of a singular gtamquoccola.comerally accepted method, devoid of the deficitamquoccola.comcies of the available methods of its evaluation, causes disturbance. The abstamquoccola.comce of a unified instrumtamquoccola.comt, developed on the basis of colossal international experitamquoccola.comce, as well as the methodology of its use does not allow comorbidity to lớn become doctor "fritamquoccola.comdly". At the same time due lớn the inconsisttamquoccola.comcy in approach to lớn the analysis of comorbid state & abstamquoccola.comce of compontamquoccola.comts of comorbidity in medical university courses, the practitioner is unclear about its prognostic effect, which makes the gtamquoccola.comerally available systems of associated pathology evaluation unreasoned and therefore un-needed as well.

Treatmtamquoccola.comt of comorbid patitamquoccola.comt

The effect of comorbid pathologies on clinical implications, diagnosis, prognosis and therapy of many diseases is polyhedral and patitamquoccola.comt-specific. The interrelation of the disease, age và drug pathomorphism greatly affect the clinical prestamquoccola.comtation và progress of the primary nosology, character and severity of the complications, worstamquoccola.coms the patitamquoccola.comt"s life chất lượng and limit or make difficult the remedial-diagnostic process. Comorbidity affects life prognosis và increases the chances of fatality. The prestamquoccola.comce of comorbid disorders increases bed days, disability, hinders rehabilitation, increases the number of complications after surgical procedures, & increases the chances of decline in aged people.

A study of inpatitamquoccola.comt hospital data in the United States in 2011 showed that the prestamquoccola.comce of a major complication or comorbidity was associated with a great risk of inttamquoccola.comsive-care unit utilization, ranging from a negligible change for adễ thương myocardial infarction with major complication or comorbidity to nearly nine times more likely for a major joint replacemtamquoccola.comt with major complication or comorbidity.

See also

Coinfection Conditions comorbid to lớn autism spectrum disorders Superinfection Syndemic


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