Template for determining a patient's comorbidity score
Comorbidities . | Points . |
|---|---|
| Hypertension | 0 |
| Angina | 0 |
| Arrhythmia | 0 |
| Gastrointestinal disease (not ulcer) | 0 |
| Pulmonary disease (mild) | 0 |
| Renal disease (mild) | 0 |
| Endocrine disease (not diabetes) | 0 |
| Myocardial infarction | 1 |
| Congestive heart failure | 1 |
| Peripheral vascular disease | 1 |
| Cerebrovascular disease | 1 |
| Dementia | 1 |
| Peptic ulcer | 1 |
| Liver disease (mild) | 1 |
| Pulmonary disease (moderate/severe) | 1 |
| Connective/rheumatologic | 1 |
| Diabetes (no end organ damage) | 1 |
| Diabetes (end organ damage) | 2 |
| Renal disease (moderate/severe) | 2 |
| Hemiplegia | 2 |
| Liver disease (moderate/severe) | 3 |
| Solid tumor (no metastases) | 2 |
| Solid tumor (metastatic) | 6 |
| AIDS | 6 |
| Other/comment | |
| Patient's score | Total |
Comorbidities . | Points . |
|---|---|
| Hypertension | 0 |
| Angina | 0 |
| Arrhythmia | 0 |
| Gastrointestinal disease (not ulcer) | 0 |
| Pulmonary disease (mild) | 0 |
| Renal disease (mild) | 0 |
| Endocrine disease (not diabetes) | 0 |
| Myocardial infarction | 1 |
| Congestive heart failure | 1 |
| Peripheral vascular disease | 1 |
| Cerebrovascular disease | 1 |
| Dementia | 1 |
| Peptic ulcer | 1 |
| Liver disease (mild) | 1 |
| Pulmonary disease (moderate/severe) | 1 |
| Connective/rheumatologic | 1 |
| Diabetes (no end organ damage) | 1 |
| Diabetes (end organ damage) | 2 |
| Renal disease (moderate/severe) | 2 |
| Hemiplegia | 2 |
| Liver disease (moderate/severe) | 3 |
| Solid tumor (no metastases) | 2 |
| Solid tumor (metastatic) | 6 |
| AIDS | 6 |
| Other/comment | |
| Patient's score | Total |
Adapted from Charlson et al.18,19