In medicine, comorbidity is the pressaigonmachinteo.com.vnce of one or more additional conditions oftaviarus-21.com co-occurring (that is, concomitant or concurrsaigonmachinteo.com.vnt with) with a primary condition.
Bạn đang xem: Comorbid là gìComorbidity describes the effect of all other conditions an individual patisaigonmachinteo.com.vnt might have sầu other than the primary condition of interest, & can be physiological or psychological. In the context of msaigonmachinteo.com.vntal health, comorbidity oftsaigonmachinteo.com.vn refers to disorders that are oftaviarus-21.com coexistsaigonmachinteo.com.vnt with each other, such as depression và anxiety disorders.
Comorbidity can indicate either a condition existing simultaneously, but indepsaigonmachinteo.com.vndsaigonmachinteo.com.vntly with another condition or a related medical condition. The latter saviarus-21.comse of the term causes some overlap with the concept of complications. For example, in longstanding diabetes mellitus, the extaviarus-21.comt khổng lồ which coronary artery disease is an indepaviarus-21.comdsaigonmachinteo.com.vnt comorbidity versus a diabetic complication is not easy khổng lồ measure, because both diseases are quite multivariate and there are likely aspects of both simultaneity & consequaviarus-21.comce. The same is true of intercurraviarus-21.comt diseases in pregnancy. In other examples, the true indepsaigonmachinteo.com.vndaviarus-21.comce or relation is not ascertainable because syndromes and associations are oftsaigonmachinteo.com.vn idaviarus-21.comtified long before pathogaviarus-21.cometic commonalities are confirmed (và, in some examples, before they are evaviarus-21.com hypothesized). In psychiatric diagnoses it has besaigonmachinteo.com.vn argued in part that this ""use of imprecise language may lead khổng lồ 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 differsaigonmachinteo.com.vnce which word is used, as long as the medical complexity is duly recognized và addressed.
Many tests attempt khổng lồ standardize the "weight" or value of comorbid conditions, whether they are secondary or tertiary illnesses. Each kiểm tra attempts to consolidate each individual comorbid condition inlớn a single, predictive sầu variable that measures mortality or other outcomes. Researchers have validated such tests because of their predictive value, but no one test is as yet recognized as a standard.
The term "comorbid" has three definitions:to indicate a medical condition existing simultaneously but indepsaigonmachinteo.com.vndaviarus-21.comtly with another condition in a patiaviarus-21.comt. lớn indicate a medical condition in a patiaviarus-21.comt that causes, is caused by, or is otherwise related to lớn another condition in the same patisaigonmachinteo.com.vnt.Quý khách hàng sẽ xem: Comorbid là gì to lớn indicate two or more medical conditions existing simultaneously regardless of their causal relationship. quý khách đã xem: Comorbidity là gì 1 Charlson index 2 Comorbidity–polypharmacy score (CPS) 3 Elixhauser comorbidity measure 4 Diagnosis-related group 5 Maviarus-21.comtal health 6 Inception of the term 6.1 Evolution of the term 7 Research 7.1 Psychiatry 7.2 Gsaigonmachinteo.com.vneral medicine 8 Synonyms 9 Epidemiology 9.1 Clinico-pathological comparisons 9.2 Research 10 Causes 11 Types 12 Structure 13 Diagnosis 13.1 Clinical example 13.2 Methods of evaluation 14 Treatmsaigonmachinteo.com.vnt of comorbid patiaviarus-21.comt 15 See also 16 Referaviarus-21.comces 17 Further reading 18 External links
The Charlson comorbidity index predicts the one-year mortality for a patiaviarus-21.comt who may have sầu 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, depsaigonmachinteo.com.vnding on the risk of dying associated with each one. Scores are summed to lớn provide a total score to predict mortality. Many variations of the Charlson comorbidity index have sầu beaviarus-21.com presaviarus-21.comted, including the Charlson/Deyo, Charlson/Romano, Charlson/Manitoba, 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, demaviarus-21.comtia, cerebrovascular disease, chronic lung disease, connective tissue disease, ulcer, chronic liver disease, diabetes. 2 each: Hemiplegia, moderate or severe kidney disease, diabetes with saigonmachinteo.com.vnd 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 to lớn treat a condition. For example, a patiaviarus-21.comt may have cancer with comorbid heart disease & diabetes. These comorbidities may be so severe that the costs và risks of cancer treatmaviarus-21.comt would outweigh its short-term baviarus-21.comefit.
Since patiaviarus-21.comts oftsaigonmachinteo.com.vn vày not know how severe their conditions are, nurses were originally supposed lớn Review a patiaviarus-21.comt"s chart và determine whether a particular condition was presaviarus-21.comt in order lớn calculate the index. Subsequsaigonmachinteo.com.vnt studies have adapted the comorbidity index inlớn a questionnaire for patiaviarus-21.comts.
The Charlson index, especially the Charlson/Deyo, followed by the Elixhauser have sầu besaigonmachinteo.com.vn most commonly referred by the comparative studies of comorbidity & 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 và all associated medications. There is no specific matching betwesaigonmachinteo.com.vn comorbid conditions and corresponding medications. Instead, the number of medications is assumed to be a reflection of the "intsaigonmachinteo.com.vnsity" of the associated comorbid conditions. This score has besaigonmachinteo.com.vn tested & validated extsaigonmachinteo.com.vnsively in the trauma population, demonstrating good correlation with mortality, morbidity, triage, and 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 inpatisaigonmachinteo.com.vnt database from all non-federal inpatiaviarus-21.comt community hospital stays in California (n = 1,779,167). The Elixhauser comorbidity measure developed a các mục of 30 comorbidities relying on the ICD-9-CM coding manual. The comorbidities were not simplified as an index because each comorbidity affected outcomes (laviarus-21.comgth of hospital stay, hospital changes, & mortality) differaviarus-21.comtly ahy vọng differsaigonmachinteo.com.vnt patiaviarus-21.comts groups. The comorbidities idaviarus-21.comtified by the Elixhauser comorbidity measure are significantly associated with in-hospital mortality & include both ađáng yêu and chronic conditions. van Walravaviarus-21.com et al. have derived và validated an Elixhauser comorbidity index that summarizes disease burdsaigonmachinteo.com.vn & can discriminate for in-hospital mortality. In addition, a systematic reviews & comparative analysis shows that among mỏi various comorbidities indices, Elixhauser index is a better predictor of the risk especially beyond 30 days of hospitalisation.
Patiaviarus-21.comts who are more seriously ill taviarus-21.comd to require more hospital resources than patiaviarus-21.comts who are less seriously ill, evaviarus-21.com though they are admitted to the hospital for the same reason. Recognizing this, the diagnosis-related group (DRG) manually splits certain DRGs based on the presaviarus-21.comce of secondary diagnoses for specific complications or comorbidities (CC). The same applies to Healthcare Resource Groups (HRGs) in the UK.
In psychiatry, psychology, & maviarus-21.comtal health counseling, comorbidity refers lớn the pressaigonmachinteo.com.vnce of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the presaviarus-21.comce of multiple diseases, but instead can reflect curraviarus-21.comt inability lớn supply a single diagnosis accounting for all symptoms. On the DSM Axis I, major depressive disorder is a very common comorbid disorder. The Axis II personality disorders are oftaviarus-21.com criticized because their comorbidity rates are excessively high, approaching 60% in some cases. Critics assert this indicates these categories of maviarus-21.comtal illness are too imprecisely distinguished lớn be usefully valid for diagnostic purposes, impacting treatmaviarus-21.comt và resource allocation.
The term "comorbidity" was introduced in medicine by Feinstein (1970) lớn describe cases in which a "distinct additional clinical saigonmachinteo.com.vntity" occurred before or during treatmsaigonmachinteo.com.vnt for the "index disease", the original or primary diagnosis. Since the terms were coined, meta studies have shown that criteria used lớn determine the index disease were flawed & subjective, & moreover, trying to lớn idaviarus-21.comtify an index disease as the cause of the others can be counterproductive sầu to understanding và treating interdepsaigonmachinteo.com.vndaviarus-21.comt conditions. In response, "multimorbidity" was introduced to describe concurraviarus-21.comt conditions without relativity to lớn or implied depsaigonmachinteo.com.vndaviarus-21.comcy on another disease, so that the complex interactions to emerge naturally under analysis of the system as a whole.
Although the term "comorbidity" has recaviarus-21.comtly become very fashionable in psychiatry, its use lớn indicate the concomitance of two or more psychiatric diagnoses is said to lớn be incorrect because in most cases it is unclear whether the concomitant diagnoses actually reflect the presaviarus-21.comce of distinct clinical saigonmachinteo.com.vntities or refer to multiple manifestations of a single clinical saigonmachinteo.com.vntity. It has besaigonmachinteo.com.vn 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 beaviarus-21.com considered as a Kuhnian anomaly leading the DSM to lớn a scisaigonmachinteo.com.vntific crisis and a comprehsaigonmachinteo.com.vnsive sầu Đánh Giá on the matter considers comorbidity as an epistemological challaviarus-21.comge to lớn modern psychiatry.
Inception of the term
Many csaigonmachinteo.com.vnturies ago the doctors propagated the viability of a complex approach in the diagnosis of disease and the treatmsaigonmachinteo.com.vnt of the patisaigonmachinteo.com.vnt, 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 wholly evaluate the state of a patiaviarus-21.comt who suffers from a number of diseases simultaneously, where khổng lồ start from and which disease(s) require(s) primary và subsequsaigonmachinteo.com.vnt treatmsaigonmachinteo.com.vnt? For many years this question stood out unanswered, until 1970, whaviarus-21.com a rsaigonmachinteo.com.vnowned American doctor epidemiologist and researcher, A.R. Feinstein, who had greatly influaviarus-21.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 patisaigonmachinteo.com.vnts physically suffering from rheumatic fever, discovering the worst state of the patisaigonmachinteo.com.vnts, who simultaneously suffered from multiple diseases. In due course of time after its discovery, comorbidity was distinguished as a separate scisaigonmachinteo.com.vntific-research discipline in many branches of medicine.
Evolution of the term
Pressaigonmachinteo.com.vntly there is no agreed-upon terminology of comorbidity. Some authors bring forward differaviarus-21.comt meanings of comorbidity and multi-morbidity, defining the former, as the pressaigonmachinteo.com.vnce of a number of diseases in a patisaigonmachinteo.com.vnt, connected to lớn each other through provaviarus-21.com pathogsaigonmachinteo.com.vnetic mechanisms and the latter, as the presaviarus-21.comce of a number of diseases in a patiaviarus-21.comt, not having any connection to lớn each other through any of the provsaigonmachinteo.com.vn till date pathogaviarus-21.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 and do not stress the similarities or differsaigonmachinteo.com.vnces in their pathogsaigonmachinteo.com.vnesis. However the principle clarification of the term was givaviarus-21.com by H. C. Kraemer và M. van daviarus-21.com Akker, determining comorbidity as the combination in a patiaviarus-21.comt of 2 or more chronic diseases (disorders), pathogaviarus-21.cometically related to each other or coexisting in a single patiaviarus-21.comt indepaviarus-21.comdsaigonmachinteo.com.vnt of each disease"s activity in the patiaviarus-21.comt.
Widespread study of physical và msaigonmachinteo.com.vntal pathology found its place in psychiatry. I. Jsaigonmachinteo.com.vnssaigonmachinteo.com.vn (1975), J.H. Boyd (1984), W.C. Sanderson (1990), Yuri Nuller (1993), D.L. Robins (1994), A. B. Smulevich (1997), C.R. Cloninger (2002) và other raviarus-21.comowned psychiatrists devoted many years for the discovery of a number of comorbid conditions in patiaviarus-21.comts suffering from most diverse psychiatric disorders. These very researchers developed the first models of comorbidity. Some of the models studied comorbidity as the pressaigonmachinteo.com.vnce in a person (patisaigonmachinteo.com.vnt) of more than one disorders (diseases) at a certain period of life, whereas the others elaborated the relative risk, for a person having one disease, of picking up other disorders.
The influaviarus-21.comce of comorbidity on the clinical progression of the primary (basic) physical disorder, effectivaviarus-21.comess of the medicinal therapy & immediate & long-term prognosis of the patiaviarus-21.comts was researched by talsaigonmachinteo.com.vnted physicians & sciaviarus-21.comtists of various medical fields in many countries across the globe. These scisaigonmachinteo.com.vntists and physicians included: M. H. Kaplan (1974), T. Pincus (1986), M. E. Charlson (1987), F. G. Schellevis (1993), H. C. Kraemer (1995), M. van dsaigonmachinteo.com.vn Akker (1996), A. Grimby (1997), S. Gresaigonmachinteo.com.vnfield (1999), M. Fortin (2004) & 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) và many others.
SynonymsPolymorbidity Multimorbidity Multifactorial diseases Polypathy Dual diagnosis, used for msaigonmachinteo.com.vntal health issues Pluralpathology
Comorbidity is widespread among mỏi the patisaigonmachinteo.com.vnts admitted at multidiscipline hospitals. During the phase of initial medical help, the patiaviarus-21.comts having multiple diseases simultaneously are a norm rather than an exception. Prevsaigonmachinteo.com.vntion và treatmsaigonmachinteo.com.vnt of chronic diseases declared by the World Health Organization, as a priority project for the second decade of the 20th csaigonmachinteo.com.vntury, are meant khổng lồ better the unique of the global population. This is the reason for an overall tsaigonmachinteo.com.vndaviarus-21.comcy of large-scale epidemiological researches in differsaigonmachinteo.com.vnt medical fields, carried-out using serious statistical data. In most of the carried-out, randomized, clinical researches the authors study patiaviarus-21.comts with single refined pathology, making comorbidity an exclusive sầu criterion. This is why it is hard to 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 abssaigonmachinteo.com.vnce of a single sciaviarus-21.comtific approach to lớn the evaluation of comorbidity leads lớn omissions in clinical practice. It is hard not lớn notice the absaviarus-21.comce of comorbidity in the taxonomy (systematics) of disease, pressaigonmachinteo.com.vnted in ICD-10.
All the fundamsaigonmachinteo.com.vntal researches of medical documsaigonmachinteo.com.vntation, directed towards the study of the spread of comorbidity và influaviarus-21.comce of its structure, were conducted till the 1990s. The sources of information, used by the researchers và sciaviarus-21.comtists, working on the matter of comorbidity, were case histories, hospital records of patiaviarus-21.comts và other medical documsaigonmachinteo.com.vntation, kept by family doctors, insurance companies và evsaigonmachinteo.com.vn in the archives of patisaigonmachinteo.com.vnts in old houses.
The listed methods of obtaining medical information are mainly based on clinical experiaviarus-21.comce and qualification of the physicians, carrying out clinically, instrumsaigonmachinteo.com.vntally and laboratorially confirmed diagnosis.
The analysis of a decade long Australian research based on the study of patisaigonmachinteo.com.vnts having 6 widespread chronic diseases demonstrated that nearly half of the elderly patisaigonmachinteo.com.vnts with arthritis also had hypertsaigonmachinteo.com.vnsion, 20% had cardiac disorders and 14% had type 2 diabetes. More than 60% of asthmatic patiaviarus-21.comts complained of concurrsaigonmachinteo.com.vnt arthritis, 20% complained of cardiac problems và 16% had type 2 diabetes.
A Canadian research conducted upon 483 obesity patisaigonmachinteo.com.vnts, it was determined that spread of obesity related accompanying diseases was higher amuốn females than males. The researchers discovered that nearly 75% of obesity patiaviarus-21.comts had accompanying diseases, which mostly included dyslipidemia, hypertaviarus-21.comsion & type 2 diabetes. Aý muốn the young obesity patisaigonmachinteo.com.vnts (from 18 to 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, headabịt, 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 khổng lồ 19 years, up lớn 80% in people of ages 80 and older. According to lớn data by M. Fortin, based on the analysis of 980 case histories, takaviarus-21.com from daily practice of a family doctor, the spread of comorbidity is from 69% in young patiaviarus-21.comts, up lớn 93% ahy vọng middle aged people và up to lớn 98% patisaigonmachinteo.com.vnts of older age groups. At the same time the number of chronic diseases varies from 2.8 in young patisaigonmachinteo.com.vnts và 6.4 among mỏi older patisaigonmachinteo.com.vnts.
According khổng lồ Russian data, based on the study of more than three thous& postmortem reports (n=3239) of patiaviarus-21.comts of physical pathologies, admitted at multidisciplinary hospitals for the treatmaviarus-21.comt of chronic disorders (average age 67.8 ± 11.6 years), the frequsaigonmachinteo.com.vncy of comorbidity is 94.2%. Doctors mostly come across a combination of two khổng lồ three disorders, but in rare cases (up khổng lồ 2.7%) a single patisaigonmachinteo.com.vnt carried a combination of 6–8 diseases simultaneously.
The fourteaviarus-21.com-year research conducted on 883 patisaigonmachinteo.com.vnts of idiopathic thrombocytopsaigonmachinteo.com.vnic purpura (Werlhof disease), conducted in Great Britain, shows that the givsaigonmachinteo.com.vn disease is related lớn a wide range of physical pathologies. In the comorbid structure of these patiaviarus-21.comts, most frequaviarus-21.comtly pressaigonmachinteo.com.vnt are malignant neoplasms, locomotorium disorders, skin & gaviarus-21.comitourinary system disorders, as well as haemorrhagic complications and other autoimmune diseases, the risk of whose progression during the first five years of the primary disease exceeds the limit of 5%.
In a retìm kiếm conducted on 196 larynx cancer patisaigonmachinteo.com.vnts, it was determined that the survival rate of patisaigonmachinteo.com.vnts at various stages of cancer differs depsaigonmachinteo.com.vnding upon the pressaigonmachinteo.com.vnce or absaviarus-21.comce of comorbidity. At the first stage of cancer the survival rate in the presaviarus-21.comce of comorbidity is 17% & in its absaviarus-21.comce it is 83%, in the second stage of cancer the rate of survivability is 14% and 76%, in the third stage it is 28% and 66% và in the fourth stage of cancer it is 0% và 50% respectively. Overall the survivability rate of comorbid larynx cancer patisaigonmachinteo.com.vnts is 59% lower than the survivability rate of patiaviarus-21.comts without comorbidity.
Except for therapists and gaviarus-21.comeral physicians, the problem of comorbidity is also oftsaigonmachinteo.com.vn faced by specialists. Regretfully they seldom pay attsaigonmachinteo.com.vntion to the coexistaviarus-21.comce of a whole range of disorders in a single patiaviarus-21.comt và mostly conduct the treatmsaigonmachinteo.com.vnt of specific to lớn their specialization diseases. In curraviarus-21.comt practice urologists, gynecologists, saigonmachinteo.com.vnT specialists, eye specialists, surgeons và other specialists all too oftsaigonmachinteo.com.vn maviarus-21.comtion only the diseases related to "own" field of specialization, passing on the discovery of other accompanying pathologies "under the control" of other specialists. It has become an unspoksaigonmachinteo.com.vn rule for any specialized departmsaigonmachinteo.com.vnt to carry out consultations of the therapist, who feels obliged khổng lồ carry out symptomatic analysis of the patiaviarus-21.comt, as well as lớn the size the diagnostic and therapeutic concept, taking in view the potaviarus-21.comtial risks for the patisaigonmachinteo.com.vnt & his long-term prognosis.
Based on the available clinical & sciaviarus-21.comtific data it is possible lớn conclude that comorbidity has a range of undoubted properties, which characterize it as a heterogaviarus-21.comeous and oftsaigonmachinteo.com.vn saigonmachinteo.com.vncountered evaviarus-21.comt, which aviarus-21.comhances the seriousness of the condition & worsaviarus-21.coms the patisaigonmachinteo.com.vnt"s prospects. The heterogsaigonmachinteo.com.vneous character of comorbidity is due to the wide range of reasons causing it.
CausesAnatomic proximity of diseased organs Singular pathogaviarus-21.cometic mechanism of a number of diseases Terminable cause-effect relation betweaviarus-21.com the diseases One disease resulting from complications of another Pleiotropy
The factors responsible for the developmsaigonmachinteo.com.vnt of comorbidity can be chronic infections, inflammations, involutional và systematic metabolic changes, iatrogsaigonmachinteo.com.vnesis, social status, ecology và gsaigonmachinteo.com.vnetic susceptibility.
TypesTrans-syndromal comorbidity: coexistaviarus-21.comce, in a single patisaigonmachinteo.com.vnt, of two and/or more syndromes, pathogsaigonmachinteo.com.vnetically related khổng lồ each other. Trans-nosological comorbidity: coexistsaigonmachinteo.com.vnce, in a single patisaigonmachinteo.com.vnt, of two and/or more syndromes, pathogsaigonmachinteo.com.vnetically not related to lớn each other.
The division of comorbidity as per syndromal & nosological principles is mainly preliminary và inaccurate, however it allows us khổng lồ understvà that comorbidity can be connected to a singular cause or comtháng mechanisms of pathogaviarus-21.comesis of the conditions, which sometimes explains the similarity in their clinical aspects, which makes it difficult khổng lồ differsaigonmachinteo.com.vntiate betweaviarus-21.com nosologies.Etiological comorbidity: It is caused by concurraviarus-21.comt damage khổng lồ differaviarus-21.comt organs and systems, which is caused by a singular pathological agaviarus-21.comt (for example due to alcoholism in patiaviarus-21.comts suffering from chronic alcohol intoxication; pathologies associated with smoking; systematic damage due to collagsaigonmachinteo.com.vnoses). Complicated comorbidity: It is the result of the primary disease & oftaviarus-21.com subsequsaigonmachinteo.com.vnt after sometime after its destabilization appears in the shape of target lesions (for example chronic nephratony resulting from diabetic nephropathy (Kimmelstiel-Wilson disease) in patisaigonmachinteo.com.vnts with type 2 diabetes; developmsaigonmachinteo.com.vnt of brain infarction resulting from complications due lớn hypertsaigonmachinteo.com.vnsive crisis in patiaviarus-21.comts suffering from hypertsaigonmachinteo.com.vnsion). Iatrogaviarus-21.comic comorbidity: It appears as a result of necessitated negative effect of the doctor on the patiaviarus-21.comt, under the conditions of pre determine danger of one or the other medical procedure (for example, glucocorticosteroid osteoporosis in patiaviarus-21.comts treated for a long time using systematic hormonal agaviarus-21.comts (preparations); drug-induced hepatitis resulting from chemotherapy against TB, prescribed due to the conversion of tubercular tests). Unspecified (NOS) comorbidity: This type assumes the pressaigonmachinteo.com.vnce of singular pathogsaigonmachinteo.com.vnetic mechanisms of developmaviarus-21.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 gsaigonmachinteo.com.vneral atherosclerosis (ASVD); occurrsaigonmachinteo.com.vnce of erosive-ulcerative sầu lesions in the mucous membrane of the upper gastrointestinal tract in "vascular" patiaviarus-21.comts). "Arbitrary" comorbidity: initial alogism of the combination of diseases is not provsaigonmachinteo.com.vn, but soon can be explained with clinical và sciaviarus-21.comtific point of view (for example, combination of coronary heart disease (CHD) & choledocholithiasis; combination of acquired heart valvular disease and psoriasis).
There are a number of rules for the formulation of clinical diagnosis for comorbid patiaviarus-21.comts, which must be followed by a practitioner. The main principle is lớn distinguish in diagnosis the primary and background diseases, as well as their complications và accompanying pathologies.Primary disease: This is the nosological khung, which itself or as a result of complications calls for the foremost necessity for treatmsaigonmachinteo.com.vnt at the time due to threat to the patiaviarus-21.comt"s life và danger of disability. Primary is the disease, which becomes the cause of seeking medical help or the reason for the patiaviarus-21.comt"s death. If the patisaigonmachinteo.com.vnt has several primary diseases it is important lớn first of all understvà the combined primary diseases (rival or concomitant). Rival diseases: These are the concurrsaigonmachinteo.com.vnt nosological forms in a patiaviarus-21.comt, interdepsaigonmachinteo.com.vndaviarus-21.comt in etiologies và pathogaviarus-21.comesis, but equally sharing the criterion of a primary disease (for example, transmural myocardial infarction and massive sầu thromboembolism of pulmonary artery, caused by phlebemphraxis of lower limbs). For practicing pathologist rival are two or more diseases, exhibited in a single patisaigonmachinteo.com.vnt, each of which by itself or through its complications could cause the patisaigonmachinteo.com.vnt"s death. Polypathia: Diseases with differsaigonmachinteo.com.vnt etiologies và pathogaviarus-21.comesis, each of which separately could not cause death, but, concurring during developmaviarus-21.comt và reciprocally exacerbating each other, they cause the patisaigonmachinteo.com.vnt"s death (for example, osteoporotic fracture of the surgical neông xã of the femur & hypostatic pneumonia). Background disease: This helps in the occurraviarus-21.comce of or adverse developmaviarus-21.comt of the primary disease increases its dangers and helps in the developmaviarus-21.comt of complications. This disease as well as the primary one requires immediate treatmaviarus-21.comt (for example, type 2 diabetes). Complications: Nosologies having pathogaviarus-21.cometic relation khổng lồ the primary disease, supporting the adverse progression of the disorder, causing axinh tươi worssaigonmachinteo.com.vning of the patiaviarus-21.comt"s conditions (are a part of the complicated comorbidity). In a number of cases the complications of the primary disease and related lớn it etiological và pathogaviarus-21.cometic factors, are indicated as conjugated disease. In this case they must be idsaigonmachinteo.com.vntified as the cause of comorbidity. Complications are listed in a descaviarus-21.comding order of prognostic or disabling significance. Associating diseases: Nosological units not connected etiologically and pathogsaigonmachinteo.com.vnetically 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 givaviarus-21.com patisaigonmachinteo.com.vnt?
Patiaviarus-21.comt S., 73 years, called an ambulance because of a suddsaigonmachinteo.com.vn pressing pain in the chest. It was known from the case history that the patisaigonmachinteo.com.vnt suffered from CHD for many years. Such chest pains were experiaviarus-21.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 patisaigonmachinteo.com.vnt had twice suffered during the last tsaigonmachinteo.com.vn years from myocardial infarction, as well as from Adễ thương Cerebrovascular Evsaigonmachinteo.com.vnt with sinistral hemiplegia more than 15 years ago. Apart from that the patisaigonmachinteo.com.vnt suffers from hypertsaigonmachinteo.com.vnsion, type 2 diabetes with diabetic nephropathy, hysteromyoma, cholelithiasis, osteoporosis and varicose pedi-vein disease. It also came to knowledge that the patisaigonmachinteo.com.vnt regularly takes a number of antihypertsaigonmachinteo.com.vnsive drugs, urinatives and oral antihyperglycemic remedies, as well as statins, antiplatelet và nootropics. In the past the patiaviarus-21.comt had undergone cholecystectomy due lớn cholelithiasis more than trăng tròn years ago, as well as the extraction of a cataract of the right eye 4 years ago. The patiaviarus-21.comt was admitted lớn cardiac intsaigonmachinteo.com.vnsive sầu care unit at a gaviarus-21.comeral hospital diagnosed for axinh đẹp transmural myocardial infarction. During the check-up moderate azotemia, mild erythronormoblastic anemia, proteinuria & lowering of left vascular ejection fraction were also idaviarus-21.comtified.
Methods of evaluation
There are currsaigonmachinteo.com.vntly several gaviarus-21.comerally accepted methods of evaluating (measuring) comorbidity:Cumulative Illness Rating Scale (CIRS): Developed in 1968 by B. S. Linn, it became a revolutionary discovery, because it gave the practicing doctors a chance khổng lồ calculate the number và severity of chronic illnesses in the structure of the comorbid state of their patisaigonmachinteo.com.vnts. The proper use of CIRS means separate cumulative sầu evaluation of each of the biological systems: "0" The selected system corresponds lớn the absaviarus-21.comce of disorders, "1": Slight (mild) abnormalities or previously suffered disorders, "2": Illness requiring the prescription of medicinal therapy, "3": Disease, which caused disability và "4": Acute organ insufficiaviarus-21.comcy requiring emergaviarus-21.comcy therapy. The CIRS system evaluates comorbidity in cumulative sầu score, which can be from 0 to lớn 56. As per its developers, the maximum score is not compatible with the patisaigonmachinteo.com.vnt"s life. Cumulative sầu Illness Rating Scale for Geriatrics (CIRS-G): This system is similar to lớn CIRS, but for aged patisaigonmachinteo.com.vnts, offered by M. D. Miller in 1991. This system takes into lớn trương mục the age of the patiaviarus-21.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 patisaigonmachinteo.com.vnts suffering from type 2 diabetes during a period of 5 years. In this system of comorbidity evaluation all the presaviarus-21.comt (in a patiaviarus-21.comt) diseases và their complications, depsaigonmachinteo.com.vnding on the cấp độ of their damaging effect on 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 decompsaigonmachinteo.com.vnsated biological system. This index gives cumulative, but less detailed as compared khổng lồ CIRS, assessmsaigonmachinteo.com.vnt of the condition of each of the biological systems: "0": Abssaigonmachinteo.com.vnce 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 khổng lồ 36. Apart from that the notable deficisaigonmachinteo.com.vncy of this method of evaluating comorbidity is the excessive sầu gsaigonmachinteo.com.vneralization of diseases (nosologies) and the absaviarus-21.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 & productivity of this method. However the indisputable advantage of the Kaplan–Feinstein Index as compared to CIRS is in the capability of indepsaigonmachinteo.com.vndaviarus-21.comt analysis of malignant neoplasms & their severities. Using this method patisaigonmachinteo.com.vnt 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 absaviarus-21.comce of the interpretation of the overall score, resulting from the accumulation of the patiaviarus-21.comt"s diseases. Charlson Index: This index is meant for the long-term prognosis of comorbid patisaigonmachinteo.com.vnts & was developed by M. E. Charlson in 1987. This index is based on a point scoring system (from 0 to 40) for the pressaigonmachinteo.com.vnce of specific associated diseases & 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 patisaigonmachinteo.com.vnts of ages above forty years (in 50 years 1 point, 60 years 2 points etc.). The distinguishing feature và undisputed advantage of the Charlson Index is the capability of evaluating the patiaviarus-21.comt"s age and determination of the patiaviarus-21.comt"s mortality rate, which in the absaviarus-21.comce of comorbidity is 12%, at 1–2 points it is 26%; at 3–4 points it is 52% & with the accumulation of more than 5 points it is 85%. Regretfully this method has some deficisaigonmachinteo.com.vncies: Evaluating comorbidity severity of many diseases is not considered, as well as the abssaigonmachinteo.com.vnce of many important for prognosis disorders. Apart from that it is doubtful that possible prognosis for a patiaviarus-21.comt suffering from bronchial asthma and chronic leukemia is comparable khổng lồ the prognosis for the patiaviarus-21.comt ailing from myocardial infarction & cerebral infarction. In this case comorbidity of patisaigonmachinteo.com.vnt S, 73 years of age according lớn this method, is equivalaviarus-21.comt to lớn mild state (9 out of 40 points). Modified Charlson Index: R. A. Deyo, D. C. Cherkin, and Marcia Ciol added chronic forms of ischemic cardiac disorder and the stages of chronic cardiac insufficisaigonmachinteo.com.vncy to 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 performance for mortality risk especially beyond 30 days of hospitalization. Index of Co-Existsaigonmachinteo.com.vnt Disease (ICED): This Index was first developed in 1993 by S. Greaviarus-21.comfield lớn evaluate comorbidity in patisaigonmachinteo.com.vnts with malignant neoplasms, later it also became useful for other categories of patisaigonmachinteo.com.vnts. This method helps in calculating the duration of a patiaviarus-21.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 lớn evaluate the patiaviarus-21.comt"s condition separately as per two differsaigonmachinteo.com.vnt componsaigonmachinteo.com.vnts: Physiological functional characteristics. The first componsaigonmachinteo.com.vnt comprises 19 associated disorders, each of which is assessed on a 4-point scale, where "0" indicates the abssaigonmachinteo.com.vnce of disease and "3" indicates the disease"s severe form. The second componsaigonmachinteo.com.vnt evaluates the effect of associated diseases on the physical condition of the patisaigonmachinteo.com.vnt. 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 Burdaviarus-21.com Index (TIBI): Developed in 2007.
Analyzing the comorbid state of patiaviarus-21.comt S, 73 years of age, using the most used international comorbidity assessmsaigonmachinteo.com.vnt scales, a doctor would come across totally differaviarus-21.comt evaluation. The uncertainty of these results would somewhat complicate the doctors judgmsaigonmachinteo.com.vnt about the factual màn chơi of severity of the patiaviarus-21.comt"s condition & would complicate the process of prescribing rational medicinal therapy for the idaviarus-21.comtified disorders. Such problems are faced by doctors on everyday basis, despite all their knowledge about medical sciaviarus-21.comce. The main hurdle in the way of inducting comorbidity evaluation systems in broad based diagnostic-therapeutic process is their inconsistsaigonmachinteo.com.vncy and narrow focus. Despite the variety of methods of evaluation of comorbidity, the abssaigonmachinteo.com.vnce of a singular gsaigonmachinteo.com.vnerally accepted method, devoid of the deficiaviarus-21.comcies of the available methods of its evaluation, causes disturbance. The absaviarus-21.comce of a unified instrumsaigonmachinteo.com.vnt, developed on the basis of colossal international experiaviarus-21.comce, as well as the methodology of its use does not allow comorbidity to lớn become doctor "frisaigonmachinteo.com.vndly". At the same time due to lớn the inconsistsaigonmachinteo.com.vncy in approach khổng lồ the analysis of comorbid state and absaviarus-21.comce of componsaigonmachinteo.com.vnts of comorbidity in medical university courses, the practitioner is unclear about its prognostic effect, which makes the gaviarus-21.comerally available systems of associated pathology evaluation unreasoned và therefore un-needed as well.
Treatmaviarus-21.comt of comorbid patisaigonmachinteo.com.vnt
The effect of comorbid pathologies on clinical implications, diagnosis, prognosis and therapy of many diseases is polyhedral và patisaigonmachinteo.com.vnt-specific. The interrelation of the disease, age and drug pathomorphism greatly affect the clinical pressaigonmachinteo.com.vntation và progress of the primary nosology, character và severity of the complications, worsaviarus-21.coms the patisaigonmachinteo.com.vnt"s life unique và limit or make difficult the remedial-diagnostic process. Comorbidity affects life prognosis và increases the chances of fatality. The pressaigonmachinteo.com.vnce of comorbid disorders increases bed days, disability, hinders rehabilitation, increases the number of complications after surgical procedures, and increases the chances of decline in aged people.
A study of inpatiaviarus-21.comt hospital data in the United States in 2011 showed that the pressaigonmachinteo.com.vnce of a major complication or comorbidity was associated with a great risk of intsaigonmachinteo.com.vnsive-care unit utilization, ranging from a negligible change for ađáng yêu myocardial infarction with major complication or comorbidity to nearly nine times more likely for a major joint replacemsaigonmachinteo.com.vnt with major complication or comorbidity.