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Oncology Center  

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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. Adult Comorbidity Evaluation-27    IF YOU HAVE QUESTIONS, PLEASE CALL 314-362-7508 AND ASK FOR ASSISTANCE.                              

Cogent Comorbid Ailment	Grade 3 Severe Decompensation	Grade 2 Moderate Decompensation	Grade 1 Mild Decompensation
Cardiovascular System
Myocardial Infarct	MI less than or equal to 6 months	MI grater than 6 months	MI by ECG only, Age undetermined
Angina / Coronary Artery Disease	Unstable Angina	Chronic exertional angina Recent (< 6 months) Coronary Artery Bypass Graft (CABG) or Percutaneous Transluminal Coronary Angioplasty (PTCA) Recent (< 6 months) coronary stent	ECG or stress test evidence or catheterization evidence of coronary disease without symptoms Angina pectoris not requiring hospitalization CABG or PTCA (>6mos.) Coronary stent (>6 mos.)
Congestive Heart Failure (CHF)	Hospitalized for CHF within past 6 months Ejection fraction < 20%	Hospitalized for CHF >6 months prior CHF with dyspnea which limits activities	CHF with dyspnea which has responded to treatment Exertional Dyspnea Paroxysmal Nocturnal Dyspnea (PND)
Arrhythmias	Ventricular arrhythmia < 6 months	Ventricular arrhythmia > 6 months Chronic atrial fibrillation or flutter Pacemaker	Sick Sinus Syndrome
Hypertension	DBP > 130mm Hg Sever malignant papilledema or other eye changes Encephalopathy	BDP 115-129mm Hg BDP 90-114mm Hg while taking antihypertensive medications Secondary cardiovascular symptons: vertigo, epistaxis, headaches	BDP 90-114mm Hg while NOT taking antihypertensive medications BDP < 90mm 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 with Coumadin or Heparin
Peripheral Arterial Disease	Bypass or amputation for gangrene or arterial insufficiency < 6 months ago Untreated thoracic or abdominal aneurysm (> 6cm)	Bypass or amputation for gangrene or arterial insufficiency > 6 months ago Chronic insufficiency	Intermittent claudication Untreated thoracic or abdominal aneurysm (< 6cm) s/p abdominal or thoracic aortic aneurysm repair
Respiratory System
	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%)	Restrictive Lung Disease of COPD (chronic bronchitis, emphysema, or asthma) with dyspnea which limits activities FEV1 (51% - 65%)	Restrictive Lung Disease or COPD (chronic bronchitis, emphysema, or asthma) with dyspnea which has responded to treatment FEV1 (66%-80%)
Gastrointestinal System
Hepatic	Portal hypertension and / or esophageal bleeding < 6 mos. (Encephalopathy, Ascites, Jaundice with Total Bilirubin > 2)	Chronic hepatitis, cirrhosis, portal hypertension with moderate symptoms "compensated hepatic failure"	Chronic hepatitis or cirrhosis without portal hypertension Acute hepatitis without cirrhosis Chronic liver disease manifested on biopsy or persistently elevated bilirubin (>3 mg/dl)
Stomach / Intestine	Recent Ulcers (< 6 months ago) requiring blood transfusion	Ulcers requiring surgery or transfusion > 6 months ago	Diagnosis of ulcers treated with meds Chronic malabsorption syndrome Inflammatory bowel disease (IBD) on meds or h/o with complications and/or surgery
Pancreas	Acute or Chronic pancreatitis with major complications (phlegmon, abscess, or pseudocyst)	Uncomplicated acute pancreatitis Chronic pancreatitis with minor complications (malabsorption, impaired glucose tolerance, or GI bleeding)	Chronic pancreatitis w/o complications
Renal System
End-stage Renal Disease	Creatinine > 3 mg% with multi-organ failure, shock, or sepsis Acute dialysis	Chronic Renal Insufficiency with creatinine >3 mg% Chronic Dialysis	Chronic Renal Insufficiency with creatinine 2-3 mg%.
Endocrine System
Diabetes Mellitus	Hospitalization ≤ 6 months for DKA Diabetes causing end-organ failure retinopathy neuropathy nephropathy coronary disease peripheral arterial disease	IDDM without complications Poorly controlled AODM with	AODM controlled by oral agents only
Neurological System
Stroke	Acute stroke with significant neurologic deficit	Old stroke with neurologic residual	Stroke with no residual Past or recent TIA
Dementia	Severe dementia requiring full support for activities of daily living	Moderate dementia (not completely self-sufficient, needs supervising)	Mild dementia (can take care of self)
Paralysis	Paraplegia or hemiplegia requiring full support for activities of daily living	Paraplegia or hemiplegia requiring wheelchair, able to do some self care	Paraplegia or hemiplegia, ambulatory and providing most of self care
Neuromuscular	MS, Parkinson’s, Myasthenia Gravis, or other chronic neuromuscular disorder and requiring full support for activities of daily living	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 neuromuscular disorder, but ambulatory and providing most of self care
Pshychiatric
	Recent suicidal attempt Active schizophrenia	Depression or bipolar disorder uncontrolled Schizophrenia controlled w/ meds	Depression or bipolar disorder controlled w/ medication
Rheumatologic
	Connective Tissue Disorder with secondary end-organ failure (renal, cardiac, CNS)	Connective Tissue Disorder on steroids or immunosuppressant medications	Connective Tissue Disorder on NSAIDS or no treatment
Immunological System
AIDS	Fulminant AIDS w/KS, MAI, PCP (AIDS defining illness)	HIV+ with h/o defining illness. CD4+ < 200/μL	Asymptomatic HIV+ patient. HIV+ w/o h/o AIDS defining illness. CD4+ > 200/μL
Malignancy
Solid Tumor Including Melanoma	Uncontrolled cancer Newly diagnosed but not yet treated Metastatic solid tumor	Any controlled solid tumor without documented metastases, but initially diagnosed and treated within the last 5 years	Any controlled solid tumor without documented metastases, but initially diagnosed and treated > 5 years ago
Leukemia and Myeloma	Relapse Disease out of control	1st remission or new dx <1yr Chronic suppressive therapy	H/o leukemia or myeloma with last Rx > 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	Delirium tremens	Active alcohol abuse with social, behavioral, or medical complications	H/o alcohol abuse but not presently drinking
Illicit Drugs	Acute Withdrawal Syndrome	Active substance abuse with social, behavioral, or medical complications	H/o substance abuse but not presently using
Body Weight
Obesity		Morbid (i.e., BMI > 37)