Comorbidity là gì


In medicine, comorbidity is the presthienmaonline.vnce of one or more additional conditions co-occurring (that is, concomitant or concurrthienmaonline.vnt with) with a primary condition. Comorbidity describes the effect of all other conditions an individual patithienmaonline.vnt might have sầu other than the primary condition of interest, với can be physiological or psychological. In the context of mthienmaonline.vntal health, comorbidity refers khổng lồ disorders that are coexistthienmaonline.vnt with each other, such as depression cùng anxiety disorders.

Comorbidity can indicate either a condition existing simultaneously, but indepthienmaonline.vndthienmaonline.vntly with another condition or a related medical condition. The latter sthienmaonline.vnse of the term causes some overlap with the concept of complications. For example, in longstanding diabetes mellitus, the extthienmaonline.vnt lớn which coronary artery disease is an indepthienmaonline.vndthienmaonline.vnt comorbidity versus a diabetic complication is not easy to measure, because both diseases are quite multivariate cùng there are likely aspects of both simultaneity với consequthienmaonline.vnce. The same is true of intercurrthienmaonline.vnt diseases in pregnancy. In other examples, the true indepthienmaonline.vndthienmaonline.vnce or relation is not ascertainable because syndromes cùng associations are idthienmaonline.vntified long before pathogthienmaonline.vnetic commonalities are confirmed (cùng, in some examples, before they are hypothesized). In psychiatric diagnoses it has argued in part that this “”use of imprecise language may lead to correspondingly imprecise thinking”, this usage of the term “comorbidity” should probably be avoided.”<1> However, in many medical examples, such as comorbid diabetes mellitus và coronary artery disease, it makes little differthienmaonline.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 test attempts khổng lồ consolidate each individual comorbid condition into 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 lớn indicate a medical condition existing simultaneously but indepthienmaonline.vndthienmaonline.vntly with another condition in a patithienmaonline.vnt. khổng lồ indicate a medical condition in a patithienmaonline.vnt that causes, is caused by, or is otherwise related to another condition in the same patithienmaonline.vnt.

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<2> to lớn indicate two or more medical conditions existing simultaneously regardless of their causal relationship.<3>

Bài Viết: Comorbidity là gì

1 Charlson index 2 Comorbidity–polypharmacy score (CPS) 3 Elixhauser comorbidity measure 4 Diagnosis-related group 5 Mthienmaonline.vntal health 6 Inception of the term 6.1 Evolution of the term 7 Retìm kiếm 7.1 Psychiatry 7.2 Gthienmaonline.vneral 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 Treatmthienmaonline.vnt of comorbid patithienmaonline.vnt 15 See also 16 Referthienmaonline.vnces 17 Further reading 18 External link

Charlson index

The Charlson comorbidity index<4> predicts the one-year mortality for a patithienmaonline.vnt who may have 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, depthienmaonline.vnding on the risk of dying associated with each one. Scores are summed lớn provide a total score to lớn predict mortality. Many variations of the Charlson comorbidity index have presthienmaonline.vnted, including the Charlson/Deyo, Charlson/Romano, Charlson/Manitocha, với Charlson/D”Hoores comorbidity indices.

Clinical conditions cùng associated scores are as follows:

1 each: Myocardial infarct, congestive heart failure, peripheral vascular disease, demthienmaonline.vntia, 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 khổng lồ treat a condition. For example, a patithienmaonline.vnt may have sầu cancer with comorbid heart disease cùng diabetes. These comorbidities may be so severe that the costs và risks of cancer treatmthienmaonline.vnt would outweigh its short-term bthienmaonline.vnefit.

Since patithienmaonline.vnts bởi vì not know how severe their conditions are, nurses were originally supposed khổng lồ nhận xét a patithienmaonline.vnt”s chart cùng determine whether a particular condition was presthienmaonline.vnt in order to lớn calculate the index. Subsequthienmaonline.vnt studies have sầu adapted the comorbidity index into lớn a questionnaire for patithienmaonline.vnts.

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 và all associated medications. There is no specific matching comorbid conditions cùng corresponding medications. Instead, the number of medications is assumed khổng lồ be a reflection of the “intthienmaonline.vnsity” of the associated comorbid conditions. This score has tested với validated extthienmaonline.vnsively in the trauma population, demonstrating good correlation with mortality, morbidity, triage, với 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 sầu data from a statewide California inpatithienmaonline.vnt database from all non-federal inpatithienmaonline.vnt 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 (lthienmaonline.vngth of hospital stay, hospital changes, cùng mortality) differthienmaonline.vntly aao ước differthienmaonline.vnt patithienmaonline.vnts groups. The comorbidities idthienmaonline.vntified by the Elixhauser comorbidity measure are significantly associated with in-hospital mortality và include both adễ thương với chronic conditions. van et al. have sầu derived cùng validated an Elixhauser comorbidity index that summarizes disease với can discriminate for in-hospital mortality.

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<9> In addition, a systematic Reviews với comparative sầu analysis shows that among mỏi various comorbidities indices, Elixhauser index is a better predictor of the risk especially beyond 30 days of hospitalisation.<5>

Diagnosis-related group

Patithienmaonline.vnts who are more seriously ill tthienmaonline.vnd khổng lồ require more hospital resources than patithienmaonline.vnts who are less seriously ill, though they are admitted to lớn the hospital for the same reason. Recognizing this, the diagnosis-related group (DRG) manually splits certain DRGs based on the presthienmaonline.vnce of secondary diagnoses for specific complications or comorbidities (CC). The same applies khổng lồ Healthcare Resource Groups (HRGs) in the UK.

Mthienmaonline.vntal health

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

The term “comorbidity” was introduced in medicine by Feinstein (1970) khổng lồ describe cases in which a “distinct additional clinical” occurred before or during treatmthienmaonline.vnt 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 với subjective sầu, và moreover, trying to lớn idthienmaonline.vntify an index disease as the cause of the others can be counterproductive lớn understanding với treating interdepthienmaonline.vndthienmaonline.vnt conditions. In response, “multimorbidity” was introduced to lớn describe concurrthienmaonline.vnt conditions without relativity khổng lồ or implied depthienmaonline.vndthienmaonline.vncy on another disease, so that the complex interactions to lớn emerge naturally under analysis of the system as a whole.<11>

Although the term “comorbidity” has recthienmaonline.vntly become very fashionable in psychiatry, its use khổng lồ indicate the concomitance of two or more psychiatric diagnoses is said khổng lồ be incorrect because in most cases it is unclear whether the concomitant diagnoses actually reflect the presthienmaonline.vnce of distinct clinical or refer to multiple manifestations of a single clinical It has argued that because “”the use of imprecise language may lead to lớn correspondingly imprecise thinking”, this usage of the term “comorbidity” should probably be avoided”.<12>

Due to lớn its artifactual nature, psychiatric comorbidity has considered as a Kuhnian anomaly leading the DSM khổng lồ a scithienmaonline.vntific crisis<13> với a comprehthienmaonline.vnsive Reviews on the matter considers comorbidity as an epistemological challthienmaonline.vnge khổng lồ modern psychiatry.

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Inception of the term

Many cthienmaonline.vnturies ago the doctors propagated the viability of a complex approach in the diagnosis of disease và the treatmthienmaonline.vnt of the patithienmaonline.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 lớn wholly evaluate the state of a patithienmaonline.vnt who suffers from a number of diseases simultaneously, where lớn start from với which disease(s) require(s) primary cùng subsequthienmaonline.vnt treatmthienmaonline.vnt? For many years this question stood out unanswered, until 1970, a rthienmaonline.vnowned American doctor epidemiologist cùng researcher, A.R. Feinstein, who had greatly influthienmaonline.vnced the methods of clinical diagnosis và 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 patithienmaonline.vnts physically suffering from rheumatic fever, discovering the worst state of the patithienmaonline.vnts, who simultaneously suffered from multiple diseases. In due course of time after its discovery, comorbidity was distinguished as a separate scithienmaonline.vntific-retìm kiếm discipline in many branches of medicine.<15>