Adult Comorbidity Evaluation-27
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.

Cogent comorbidailment

Grade 3Severe Decompensation

Cardiovascular System
Myocardial Infarct
 MI ≤ 6 months

Grade 2Moderate Decompensation
 MI > 6 months ago

Grade 1
Mild Decompensation
 MI by ECG only, age undetermined

Angina / Coronary
Artery Disease Unstable angina

 ECG or stress test evidence or Chronic exertional angina
catheterization evidence of coronary Recent (≤ 6 months) Coronary Arterydisease without symptoms
Bypass Graft (CABG) or Percutaneous Angina pectoris not requiring
Transluminal Coronary Angioplasty
hospitalization(PTCA) CABG or PTCA (>6 mos.) Recent (≤ 6 months) coronary stent Coronary stent (>6 mos.)Congestive Heart
Failure (CHF) Hospitalized for CHF within past 6months
 Ejection fraction < 20% Hospitalized for CHF >6 months prior  CHF with dyspnea which has
 CHF with dyspnea which limits
responded to treatmentactivities
 Exertional dyspnea
 Paroxysmal Nocturnal Dyspnea (PND)

Arrhythmias

 Ventricular arrhythmia ≤ 6 months

 Ventricular arrhythmia > 6 months
 Chronic atrial fibrillation or flutter Pacemaker Sick Sinus Syndrome Supraventricular tachycardia

Hypertension

 DBP>130 mm Hg
 Severe malignant papilledema or othereye changes
 Encephalopathy

 DBP 115-129 mm Hg
 DBP 90-114 mm Hg while takingantihypertensive medications
 Secondary cardiovascular symptoms:
vertigo, epistaxis, headaches

 DBP 90-114 mm Hg while not taking
antihypertensive medications
 DBP <90 mm Hg while taking
antihypertensive medications
 Hypertension, not otherwise specified

Venous Disease Recent PE (≤ 6 mos.) Use of venous filter for PE’s

 DVT controlled with Coumadin or
heparin Old PE > 6 months

 Old DVT no longer treated withCoumadin or Heparin

Peripheral Arterial
Disease Bypass or amputation for gangrene orarterial insufficiency < 6 months ago Untreated thoracic or abdominal
aneurysm (>6 cm)

 Bypass or amputation for gangrene orarterial insufficiency > 6 months ago
 Chronic insufficiency

 Intermittent claudication
 Untreated thoracic or abdominal
aneurysm (< 6 cm)
 s/p abdominal or thoracic aortic
aneurysm repair

 Marked pulmonary insufficiency
 Restrictive Lung Disease or COPD withdyspnea at rest despite treatment
 Chronic supplemental O2
 CO2 retention (pCO2 > 50 torr) Baseline pO2 < 50 torr
 FEV1 (< 50%)

 Restrictive Lung Disease or COPD
(chronic bronchitis, emphysema, orasthma) with dyspnea which limits
activities
 FEV1 (51%-65%)

 Restrictive Lung Disease or COPD
(chronic bronchitis, emphysema, orasthma) with dyspnea which has
responded to treatment
 FEV1 (66%-80%)

 Chronic hepatitis, cirrhosis, portal
hypertension with moderate
symptoms "compensated hepaticfailure" Chronic hepatitis or cirrhosis without
portal hypertension
 Acute hepatitis without cirrhosis
 Chronic liver disease manifested on
biopsy or persistently elevatedbilirubin (>3 mg/dl)

Respiratory System

Gastrointestinal System
Hepatic
 Portal hypertension and/or esophageal
bleeding ≤ 6 mos. (Encephalopathy,Ascites, Jaundice with Total
Bilirubin > 2)

Stomach / Intestine Recent ulcers( ≤ 6 months ago) requiring  Ulcers requiring surgery or
blood transfusiontransfusion > 6 months ago

 Diagnosis of ulcers treated with meds
 Chronic malabsorption syndrome Inflammatory bowel disease (IBD) on
meds or h/o with complications and/orsurgery

Pancreas Acute or chronic pancreatitis with majorcomplications (phlegmon, abscess, orpseudocyst)

 Chronic pancreatitis w/ocomplications

 Uncomplicated acute pancreatitis
 Chronic pancreatitis with minor
complications (malabsorption,impaired glucose tolerance, or GIbleeding)Cogent comorbidailment

Grade 3Severe Decompensation

Renal System
End-stage renal disease  Creatinine > 3 mg% with multi-organ
failure, shock, or sepsis
 Acute dialysis
Endocrine System
Diabetes Mellitus

Neurological System
StrokeGrade 2Moderate Decompensation
 Chronic Renal Insufficiency withcreatinine >3 mg%
 Chronic dialysis

Grade 1
Mild Decompensation
 Chronic Renal Insufficiency withcreatinine 2-3 mg%.

(Code the comorbid ailments with the (*) in both the Endocrine system and other organ systems if applicable)
 IDDM without complications
 AODM controlled by oral agents only
 Hospitalization ≤ 6 months for DKA
 Poorly controlled AODM with
 Diabetes causing end-organ failure
oral agents
 retinopathy neuropathy nephropathy*
 coronary disease* peripheral arterial disease* Acute stroke with significant neurologic
deficit Old stroke with neurologic residual Stroke with no residual Past or recent TIADementia Severe dementia requiring full support for
activities of daily living

 Moderate dementia (not completely  Mild dementia (can take care of self)
self-sufficient, needs supervising)

Paralysis Paraplegia or hemiplegia requiring full
support for activities of daily living

 Paraplegia or hemiplegia requiring  Paraplegia or hemiplegia, ambulatory
wheelchair, able to do some self careand providing most of self care

Neuromuscular MS, Parkinson’s, Myasthenia Gravis, orother chronic neuromuscular disorder andrequiring full support for activities of dailyliving

 MS, Parkinson’s, Myasthenia
Gravis, or other chronic
neuromuscular disorder, but able to
do some self care

 MS, Parkinson’s, Myasthenia Gravis,
or other chronic neuromusculardisorder, but ambulatory andproviding most of self care

 Recent suicidal attempt
 Active schizophrenia Depression or bipolar disorderuncontrolled Schizophrenia controlled w/ meds

 Depression or bipolar disordercontrolled w/ medication

PsychiatricRheumatologic(Incl. Rheumatoid Arthritis, Systemic Lupus, Mixed Connective Tissue Disorder, Polymyositis, Rheumatic Polymyositis)
 Connective Tissue Disorder with
 Connective Tissue Disorder on
 Connective Tissue Disorder on
secondary end-organ failure (renal,steroids or immunosuppressant
NSAIDS or no treatment
cardiac, CNS)
medications

Immunological System (AIDS should not be considered a comorbidity for Kaposi's Sarcoma or Non-Hodgkin's Lymphoma)
AIDS Fulminant AIDS w/KS, MAI, PCP (AIDS  HIV+ with h/o defining illness.
 Asymptomatic HIV+ patient.
defining illness)
CD4+ < 200/µL
 HIV+ w/o h/o AIDS defining illness.
CD4+ > 200/µL
Malignancy
Solid Tumor includingmelanoma(Excluding Cutaneous Basal Cell Ca., Cutaneous SCCA, Carcinoma in-situ, and Intraepithelial Neoplasm) Uncontrolled cancer
 Any controlled solid tumor without  Any controlled solid tumor without Newly diagnosed but not yet treateddocumented metastases, butdocumented metastases, but initially Metastatic solid tumor
initially diagnosed and treateddiagnosed and treated > 5 years ago
within the last 5 years

Leukemia andMyeloma Relapse
 Disease out of control

 1st remission or new dx <1yr Chronic suppressive therapy

 H/o leukemia or myeloma with lastRx > 1 yr prior

Lymphoma Relapse

 1st remission or new dx <1yr
 Chronic suppressive therapy

 H/o lymphoma w/ last Rx >1 yr prior

Substance Abuse
Alcohol(Must be accompanied by social, behavioral, or medical complications) Delirium tremens
 Active alcohol abuse with social,
behavioral, or medical
complications

Illicit Drugs

 Acute Withdrawal Syndrome

Body WeightObesity

 Active substance abuse with social,
behavioral, or medical
complications

 H/o substance abuse but not presentlyusing

 Morbid (i.e., BMI ≥ 38)

OVERALL COMORBIDITY SCORE (Circle one.)

Rev November 2003

 H/o alcohol abuse but not presently
drinking

01239None

Mild

Moderate

SevereUnknown

Washington University School of Medicine

Clinical Outcomes Research Office