Comorbid là gì


In medicine, comorbidity is the of one or more additional conditions co-occurring (that is, concomitant or with) with a primary condition. Comorbidity describes the effect of all other conditions an individual might have sầu other than the primary condition of interest, and can be physiological or psychological. In the context of health, comorbidity refers to disorders that are with each other, such as depression & anxiety disorders.

Comorbidity can indicate either a condition existing simultaneously, but with another condition or a related medical condition. The latter of the term causes some overlap with the concept of complications. For example, in longstanding diabetes mellitus, the lớn which coronary artery disease is an comorbidity versus a diabetic complication is not easy lớn measure, because both diseases are quite multivariate & there are likely aspects of both simultaneity & The same is true of diseases in pregnancy. In other examples, the true or relation is not ascertainable because syndromes và associations are long before 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."<1> However, in many medical examples, such as comorbid diabetes mellitus and coronary artery disease, it makes little which word is used, as long as the medical complexity is duly recognized and addressed.

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

The term "comorbid" has three definitions:

to indicate a medical condition existing simultaneously but with another condition in a to lớn indicate a medical condition in a that causes, is caused by, or is otherwise related lớn another condition in the same

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<2> lớn indicate two or more medical conditions existing simultaneously regardless of their causal relationship.<3> Quý khách hàng sẽ xem: Comorbidity là gì 1 Charlson index 2 Comorbidity–polypharmacy score (CPS) 3 Elixhauser comorbidity measure 4 Diagnosis-related group 5 health 6 Inception of the term 6.1 Evolution of the term 7 Retìm kiếm 7.1 Psychiatry 7.2 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 of comorbid 15 See also 16 17 Further reading 18 External link

Charlson index

The Charlson comorbidity index<4> predicts the one-year mortality for a 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, 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, including the Charlson/Deyo, Charlson/Romano, Charlson/Manitotía, và Charlson/D"Hoores comorbidity indices.

Clinical conditions and associated scores are as follows:

1 each: Myocardial infarct, congestive sầu heart failure, peripheral vascular disease,, cerebrovascular disease, chronic lung disease, connective sầu tissue disease, ulcer, chronic liver disease, diabetes. 2 each: Hemiplegia, moderate or severe kidney disease, diabetes with 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 may have sầu cancer with comorbid heart disease and diabetes. These comorbidities may be so severe that the costs and risks of cancer would outweigh its short-term

Since bởi vì not know how severe their conditions are, nurses were originally supposed khổng lồ đánh giá a"s chart & determine whether a particular condition was in order to lớn calculate the index. studies have sầu adapted the comorbidity index inlớn a questionnaire for

The Charlson index, especially the Charlson/Deyo, followed by the Elixhauser have sầu most commonly referred by the comparative sầu studies of comorbidity và multimorbidity measures.<5>

Comorbidity–polypharmacy score (CPS)

The comorbidity–polypharmacy score (CPS) is a simple measure that consists of the sum of all known comorbid conditions & all associated medications. There is no specific matching comorbid conditions và corresponding medications. Instead, the number of medications is assumed lớn be a reflection of the "" of the associated comorbid conditions. This score has tested and validated in the trauma population, demonstrating good correlation with mortality, morbidity, triage, and hospital readmissions.<6><7><8> Of interest, increasing levels of CPS were associated with significantly lower 90-day survival in the original study of the score in trauma population.<6>

Elixhauser comorbidity measure

The Elixhauser comorbidity measure was developed using administrative data from a statewide California database from all non-federal community hospital stays in California (n = 1,779,167). The Elixhauser comorbidity measure developed a danh 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 ( of hospital stay, hospital changes, & mortality) aước ao groups. The comorbidities by the Elixhauser comorbidity measure are significantly associated with in-hospital mortality and include both ađáng yêu and chronic conditions. van et al. have sầu derived và validated an Elixhauser comorbidity index that summarizes disease & can discriminate for in-hospital mortality.<9> In addition, a systematic nhận xét và comparative analysis shows that ahy vọng various comorbidities indices, Elixhauser index is a better predictor of the risk especially beyond 30 days of hospitalisation.<5>

Diagnosis-related group who are more seriously ill to lớn require more hospital resources than who are less seriously ill, 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 of secondary diagnoses for specific complications or comorbidities (CC). The same applies to Healthcare Resource Groups (HRGs) in the UK. health

In psychiatry, psychology, and health counseling, comorbidity refers khổng lồ the of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the of multiple diseases, but instead can reflect inability lớn supply a single diagnosis accounting for all symptoms.<10> On the DSM Axis I, major depressive disorder is a very comtháng 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 illness are too imprecisely distinguished lớn be usefully valid for diagnostic purposes, impacting & resource allocation.

The term "comorbidity" was introduced in medicine by Feinstein (1970) to lớn describe cases in which a "distinct additional clinical" occurred before or during for the "index disease", the original or primary diagnosis. Since the terms were coined, meta studies have sầu shown that criteria used to determine the index disease were flawed and subjective, & moreover, trying to lớn an index disease as the cause of the others can be counterproductive sầu to lớn understanding and treating conditions. In response, "multimorbidity" was introduced to lớn describe conditions without relativity lớn or implied on another disease, so that the complex interactions khổng lồ emerge naturally under analysis of the system as a whole.<11>

Although the term "comorbidity" has 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 of distinct clinical or refer lớn multiple manifestations of a single clinical It has argued that because ""the use of imprecise language may lead to correspondingly imprecise thinking", this usage of the term "comorbidity" should probably be avoided".<12>

Due to its artifactual nature, psychiatric comorbidity has considered as a Kuhnian anomaly leading the DSM khổng lồ a crisis<13> and a Đánh Giá on the matter considers comorbidity as an epistemological lớn modern psychiatry.<14>

Inception of the term

Many ago the doctors propagated the viability of a complex approach in the diagnosis of disease and the of the, 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 khổng lồ wholly evaluate the state of a who suffers from a number of diseases simultaneously, where to start from and which disease(s) require(s) primary and For many years this question stood out unanswered, until 1970, a American doctor epidemiologist & researcher, A.R. Feinstein, who had greatly 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 physically suffering from rheumatic fever, discovering the worst state of the, who simultaneously suffered from multiple diseases. In due course of time after its discovery, comorbidity was distinguished as a separate discipline in many branches of medicine.<15>

Evolution of the term there is no agreed-upon terminology of comorbidity. Some authors bring forward meanings of comorbidity & multi-morbidity, defining the former, as the of a number of diseases in a, connected to lớn each other through mechanisms and the latter, as the of a number of diseases in a, not having any connection lớn each other through any of the till date mechanisms.<16> Others affirm that multi-morbidity is the combination of a number of chronic or axinh tươi diseases & clinical symptoms in a person & vày not găng tay the similarities or in their<17> However the principle clarification of the term was by H. C. Kraemer & M. van Akker, determining comorbidity as the combination in a of 2 or more chronic diseases (disorders), related khổng lồ each other or coexisting in a single of each disease"s activity in the

Retìm kiếm


Widespread study of physical & pathology found its place in psychiatry. I. (1975),<18> J.H. Boyd (1984),<19> W.C. Sanderson (1990),<20> Yuri Nuller (1993),<21> D.L. Robins (1994),<22> A. B. Smulevich (1997),<23> C.R. Cloninger (2002)<24> và other psychiatrists devoted many years for the discovery of a number of comorbid conditions in suffering from most diverse psychiatric disorders. These very researchers developed the first models of comorbidity. Some of the models studied comorbidity as the in a person ( 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. medicine

The of comorbidity on the clinical progression of the primary (basic) physical disorder, of the medicinal therapy và immediate và long-term prognosis of the was researched by physicians và of various medical fields in many countries across the globe. These and physicians included: M. H. Kaplan (1974),<25> T. Pincus (1986),<26> M. E. Charlson (1987),<27> F. G. Schellevis (1993),<28> H. C. Kraemer (1995),<29> M. van Akker (1996),<30> A. Grimby (1997),<31> S. (1999),<32> M. Fortin (2004) và A. Vanasse (2004),<33> C. Hudon (2005),<34> L. B. Lazebnik (2005),<35> A. L. Vertkin (2008),<36> G. E. Caughey (2008),<37> F. I. Belyalov (2009),<38> L. A. Luchikhin (2010)<39> & many others.


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


Comorbidity is widespread among the admitted at multidiscipline hospitals. During the phase of initial medical help, the having multiple diseases simultaneously are a norm rather than an exception. & of chronic diseases declared by the World Health Organization, as a priority project for the second decade of the 20th, are meant khổng lồ better the quality of the global population.<40><41><42><43><44> This is the reason for an overall of large-scale epidemiological researches in medical fields, carried-out using serious statistical data. In most of the carried-out, randomized, clinical researches the authors study with single refined pathology, making comorbidity an exclusive criterion. This is why it is hard to relate researches, directed towards the evaluation of the combination of ones or the other separate disorders, lớn works regarding the sole retìm kiếm of comorbidity. The of a single approach lớn the evaluation of comorbidity leads to omissions in clinical practice. It is hard not lớn notice the of comorbidity in the taxonomy (systematics) of disease, in ICD-10.

Clinico-pathological comparisons

All the researches of medical, directed towards the study of the spread of comorbidity & of its structure, were conducted till the 1990s. The sources of information, used by the researchers và, working on the matter of comorbidity, were case histories,<45><46> hospital records of<47> & other medical, kept by family doctors, insurance companies<48> & in the archives of in old houses.<49>

The listed methods of obtaining medical information are mainly based on clinical & qualification of the physicians, carrying out clinically, & laboratorially confirmed diagnosis. This is why despite their, they are highly subjective sầu. No analysis of the results of postmortem of deceased was carried out for any of the comorbidity researches.


The analysis of a decade long Australian retìm kiếm based on the study of having 6 widespread chronic diseases demonstrated that nearly half of the elderly with arthritis also had, 20% had cardiac disorders & 14% had type 2 diabetes. More than 60% of asthmatic complained of arthritis, 20% complained of cardiac problems and 16% had type 2 diabetes.<50>

In with chronic kidney disease ( the of coronary heart disease is 22% higher và new coronary 3.4 times higher compared to lớn without kidney function disorders. Progression of CKD towards stage disease requiring therapy is accompanied by increasing of Coronary Heart Disease and death from cardiac arrest.

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A Canadian retìm kiếm conducted upon 483 obesity, 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 had accompanying diseases, which mostly included dyslipidemia, & type 2 diabetes. Aý muốn the young obesity (from 18 to lớn 29) more than two chronic diseases were found in 22% males và 43% females.<52>

Fibromyalgia is a condition which is comorbid with several others, including but not limited to; depression, anxiety, headabít, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, rheumatoid arthritis,<53> migraine, & panic disorder.<54>

The number of comorbid diseases increases with age. Comorbidity increases by 10% in ages up lớn 19 years, up lớn 80% in people of ages 80 and older.<55> 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, up lớn 93% aước ao middle aged people & up khổng lồ 98% of older age groups. At the same time the number of chronic diseases varies from 2.8 in young & 6.4 among older<56>

According khổng lồ Russian data, based on the study of more than three thousvà postmortem reports (n=3239) of of physical pathologies, admitted at multidisciplinary hospitals for the of chronic disorders (average age 67.8 ± 11.6 years), the of comorbidity is 94.2%. Doctors mostly come across a combination of two to lớn three disorders, but in rare cases (up to lớn 2.7%) a single carried a combination of 6–8 diseases simultaneously.<57>

The research conducted on 883 of idiopathic purpura (Werlhof disease), conducted in Great Britain, shows that the disease is related to a wide range of physical pathologies. In the comorbid structure of these, most are malignant neoplasms, locomotorium disorders, skin and system disorders, as well as haemorrhagic complications và other autoimmune diseases, the risk of whose progression during the first five years of the primary disease exceeds the limit of 5%.<58>

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

Except for therapists và physicians, the problem of comorbidity is also faced by specialists. Regretfully they seldom pay to lớn the of a whole range of disorders in a single & mostly conduct the of specific to their specialization diseases. In practice urologists, gynecologists, specialists, eye specialists, surgeons & other specialists all too 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 to carry out consultations of the therapist, who feels obliged lớn carry out symptomatic analysis of the, as well as to the form the diagnostic và therapeutic concept, taking in view the risks for the and his long-term prognosis.

Based on the available clinical and data it is possible to conclude that comorbidity has a range of undoubted properties, which characterize it as a &, which the seriousness of the condition và the"s prospects. The character of comorbidity is due to the wide range of reasons causing it.<60><61>


Anatomic proximity of diseased organs Singular mechanism of a number of diseases Terminable cause-effect relation the diseases One disease resulting from complications of another Pleiotropy<62>

The factors responsible for the of comorbidity can be chronic infections, inflammations, involutional and systematic metabolic changes,, social status, ecology and susceptibility.


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

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

Etiological comorbidity:<63> It is caused by damage khổng lồ organs và systems, which is caused by a singular pathological (for example due to lớn alcoholism in suffering from chronic alcohol intoxication; pathologies associated with smoking; systematic damage due to Complicated comorbidity: It is the result of the primary disease và after sometime after its destabilization appears in the shape of target lesions (for example chronic nephratony resulting from diabetic nephropathy (Kimmelstiel-Wilson disease) in with type 2 diabetes; of brain infarction resulting from complications due to crisis in suffering from comorbidity: It appears as a result of necessitated negative effect of the doctor on the, under the conditions of pre determine danger of one or the other medical procedure (for example, glucocorticosteroid osteoporosis in treated for a long time using systematic hormonal (preparations); drug-induced hepatitis resulting from chemotherapy against TB, prescribed due to the conversion of tubercular tests). Unspecified (NOS) comorbidity: This type assumes the of singular mechanisms of 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 atherosclerosis (ASVD); of erosive-ulcerative sầu lesions in the mucous membrane of the upper gastrointestinal tract in "vascular" "Arbitrary" comorbidity: initial alogism of the combination of diseases is not, but soon can be explained with clinical and point of view (for example, combination of coronary heart disease (CHD) và choledocholithiasis; combination of acquired heart valvular disease and psoriasis).


There are a number of rules for the formulation of clinical diagnosis for comorbid, which must be followed by a practitioner. The main principle is lớn distinguish in diagnosis the primary và background diseases, as well as their complications and accompanying pathologies.<64><65>

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

Clinical example S., 73 years, called an ambulance because of a pressing pain in the chest. It was known from the case history that the suffered from CHD for many years. Such chest pains were 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 had twice suffered during the last years from myocardial infarction, as well as from Axinh tươi Cerebrovascular with sinistral hemiplegia more than 15 years ago. Apart from that the suffers from, type 2 diabetes with diabetic nephropathy, hysteromyoma, cholelithiasis, osteoporosis and varicose pedi-vein disease. It also came to lớn knowledge that the regularly takes a number of sầu drugs, urinatives và oral antihyperglycemic remedies, as well as statins, antiplatelet và nootropics. In the past the had undergone cholecystectomy due to cholelithiasis more than đôi mươi years ago, as well as the extraction of a cataract of the right eye 4 years ago. The was admitted to lớn cardiac care unit at a hospital diagnosed for adễ thương transmural myocardial infarction. During the check-up moderate azotemia, mild erythronormoblastic anemia, proteinuria and lowering of left vascular ejection fraction were also

Methods of evaluation

There are several accepted methods of evaluating (measuring) comorbidity:<66>

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 and severity of chronic illnesses in the structure of the comorbid state of their The proper use of CIRS means separate cumulative evaluation of each of the biological systems: "0" The selected system corresponds khổng lồ the of disorders, "1": Slight (mild) abnormalities or previously suffered disorders, "2": Illness requiring the prescription of medicinal therapy, "3": Disease, which caused disability & "4": Axinh tươi organ requiring 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"s life.<67> Cumulative sầu Illness Rating Scale for Geriatrics (CIRS-G): This system is similar to CIRS, but for aged, offered by M. D. Miller in 1991. This system takes inlớn tài khoản the age of the & the peculiarities of the old age disorders.<68><69> The Kaplan–Feinstein Index: This index was created in 1973 based on the study of the effect of the associated diseases on suffering from type 2 diabetes during a period of 5 years. In this system of comorbidity evaluation all the (in a diseases & their complications, on the level of their damaging effect on toàn thân organs, are classified as mild, moderate và severe. In this case the conclusion about cumulative sầu comorbidity is drawn on the basis of the most biological system. This index gives cumulative, but less detailed as compared lớn CIRS, of the condition of each of the biological systems: "0": 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 of this method of evaluating comorbidity is the excessive of diseases (nosologies) và the 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 và productivity of this method. However the indisputable advantage of the Kaplan–Feinstein Index as compared to lớn CIRS is in the capability of analysis of malignant neoplasms & their severities.<70> Using this method 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 of the interpretation of the overall score, resulting from the accumulation of the"s diseases. Charlson Index: This index is meant for the long-term prognosis of comorbid & was developed by M. E. Charlson in 1987. This index is based on a point scoring system (from 0 to 40) for the of specific associated diseases & is used for prognosis of lethality. For its calculation the points are accumulated, according to associated diseases, as well as the addition of a single point for each 10 years of age for of ages above forty years (in 50 years 1 point, 60 years 2 points etc.). The distinguishing feature & undisputed advantage of the Charlson Index is the capability of evaluating the"s age và determination of the"s mortality rate, which in the 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 Evaluating comorbidity severity of many diseases is not considered, as well as the of many important for prognosis disorders. Apart from that it is doubtful that possible prognosis for a suffering from bronchial asthma & chronic leukemia is comparable khổng lồ the prognosis for the ailing from myocardial infarction & cerebral infarction.<4> In this case comorbidity of S, 73 years of age according to lớn this method, is to 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 to lớn this index in 1992.<71> 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.<5> Index of Disease (ICED): This Index was first developed in 1993 by S. khổng lồ evaluate comorbidity in with malignant neoplasms, later it also became useful for other categories of This method helps in calculating the duration of a"s stay at a hospital and 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"s condition separately as per two Physiological functional characteristics. The first comprises 19 associated disorders, each of which is assessed on a 4-point scale, where "0" indicates the of disease & "3" indicates the disease"s severe size. The second evaluates the effect of associated diseases on the physical condition of the 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<72> Functional Comorbidity Index (FCI): Developed in 2005.<73> Total Illness Index (TIBI): Developed in 2007.<74>

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

The effect of comorbid pathologies on clinical implications, diagnosis, prognosis và therapy of many diseases is polyhedral and The interrelation of the disease, age & drug pathomorphism greatly affect the clinical & progress of the primary nosology, character và severity of the complications, the"s life quality & limit or make difficult the remedial-diagnostic process. Comorbidity affects life prognosis và increases the chances of fatality. The of comorbid disorders increases bed days, disability, hinders rehabilitation, increases the number of complications after surgical procedures, và increases the chances of decline in aged people.<75>

The of comorbidity must be inkhổng lồ tài khoản selecting the algorithm of diagnosis and plans for any disease. It is important khổng lồ comorbid about the level of functional disorders & anatomic status of all the nosological forms (diseases). a new, as well as mildly notable symptom appears, it is necessary to lớn conduct a deep examination lớn uncover its causes. It is also necessary lớn be remembered that comorbidity leads to lớn polypragmasy (polypharmacy), i.e. simultaneous prescription of a large number of medicines, which impossible the control over the of the therapy, increases monetary & therefore reduces compliance. At the same time, polypragmasy, especially in aged, possible the of local & systematic, unwanted medicinal side-effects. These side-effects are not always considered by the doctors, because they are considered as the appearance of comorbidity & as a result become the reason for the prescription of more drugs, sealing-in the vicious circle. Simultaneous of multiple disorders requires strict consideration of compatibility of drugs và detailed of rules of rational drug therapy, based on E. M. Tareev"s principles, which state: "Each non-indicated drug is contraindicated" và B. E. Votchal said: "If the drug does not have sầu any side-effects, one must think if there is any effect at all".

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A study of hospital data in the United States in 2011 showed that the of a major complication or comorbidity was associated with a great risk of unit utilization, ranging from a negligible change for axinh đẹp myocardial infarction with major complication or comorbidity to lớn nearly nine times more likely for a major joint with major complication or comorbidity.<76>

See also

Coinfection Conditions comorbid khổng lồ autism spectrum disorders Superinfection Syndemic

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