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Failure
Criteria Point
Diagnosis of CHF requires the simultaneous presence of at least 2 value
major criteria or 1 major criterion in conjunction with 2 minor criteria. Category I: history
The Framingham Heart Study criteria are 100% sensitive and 78% No more than 4 points are allowed from each of three categories; hence the
composite score (the sum of the subtotal from each category) has a possible
specific for identifying persons with definite congestive heart failure. maximum of 12 points. The diagnosis of heart failure is classified as "definite" at a
score of 8 to 12 points, "possible" at a score of 5 to 7 points, and "unlikely" at a
score of 4 points or less.
Criteria for the Diagnosis of Diabetes Mellitus
* HbA1c (> 6.5%) examination by ADA 2011 has become one of the
criteria for DM diagnosis, if it is done at a laboratory that has been
standardized properly.
Cardiovascular Major Risk Factors
Hypertension
Cigarette smoking
Obesity (BMI >/=30): indicates body mass index
calculated as weight in kilograms divided by the
square of height in meters
Physical inactivity
Dyslipidemia
Diabetes mellitus
Microalbuminuria or estimated glomerular filtration
rate (GFR) <60 mL/min
Age (>55 years for men, >65 years for women)
Family history of premature cardiovascular disease
(men <55 years or women 65 years)
Classification Criteria for the Diagnosis of Child-Pugh Score
Systemic Lupus Erythematosus (SLE)
NKF Definition of Chronic Kidney Disease Risk Factors for Chronic Kidney Disease and Its Outcomes
Kidney damage for three or more months, as defined by structural or
functional abnormalities of the kidney, with or without decreased GFR,
manifested by pathologic abnormalities or markers of kidney damage, Type Definition Examples
including abnormalities in the composition of the blood or urine or Susceptibility Factors that increase Older age, family history of
abnormalities in imaging tests factors susceptibility to kidney chronic kidney disease, reduction
GFR < 60 mL per minute per 1.73 m2 for three months or more, with or damage in kidney mass, low birth weight,
without kidney damage U.S. racial or ethnic minority
status, low income or educational
level
NKF Classification of Chronic Kidney Disease
Initiation Factors that directly Diabetes mellitus, high blood
factors initiate kidney damage pressure, autoimmune diseases,
Stage Description† GFR (mL per Action plan systemic infections, urinary tract
minute per infections, urinary stones,
1.73 m2) obstruction of lower urinary tract,
- At increased > 60 (with risk Screening, reduction of risk drug toxicity
risk for chronic factors for factors for chronic kidney Progression Factors that cause Higher level of proteinuria, higher
kidney disease chronic kidney disease factors worsening kidney blood pressure level, poor
disease) damage and faster glycemic control in diabetes,
1 Kidney damage > 90 Diagnosis and treatment, decline in kidney smoking
with normal or treatment of comorbid function after kidney
elevated GFR conditions, interventions to slow damage has started
disease progression, reduction End-stage Factors that increase Lower dialysis dose (Kt/V)*,
of risk factors for cardiovascular factors morbidity and mortality temporary vascular access,
disease in kidney failure anemia, low serum albumin level,
2 Kidney damage 60 to 89 Estimation of disease late referral for dialysis
with mildly progression
decreased GFR
*-In Kt/V (accepted nomenclature for dialysis dose), "K" represents urea clearance,
3 Moderately 30 to 59 Evaluation and treatment of "t" represents time, and "V" represents volume of distribution for urea.
decreased GFR disease complications
4 Severely 15 to 29 Preparation for kidney
NKF = National Kidney Foundation; GFR = glomerular filtration rate.
decreased GFR replacement therapy (dialysis,
transplantation)
5 Kidney failure < 15 (or Kidney replacement therapy if
dialysis) uremia is present
Definitions for the Terms Bacteremia, Sepsis, Severe Primary MODS is the result of a well-defined insult in which organ
Sepsis, Septic Shock, and Other Related Disorders dysfunction occurs early and can be directly attributable to the insult itself
(eg, renal failure due to rhabdomyolysis).
Secondary MODS is organ failure not in direct response to the insult itself,
A 1992 American College of Chest Physicians/Society of Critical Care Medicine but as a consequence of a host response. In the context of the definitions of
consensus panel defined the following terms which are relevant to the discussion of sepsis and SIRS, MODS represent the more severe end of the spectrum of
septic shock: severity of illness characterized by SIRS/sepsis.
Infection: Infection is a microbial phenomenon characterized by an inflammatory
response to the presence of microorganisms or the invasion of normally sterile host
tissue by those organisms.
Sepsis: Sepsis is the systemic response to infection. Thus, in sepsis, the clinical
signs describing SIRS are present together with definitive evidence of infection.
Septic shock: Septic shock is sepsis with hypotension despite adequate fluid
resuscitation. It includes perfusion abnormalities such as lactic acidosis, oliguria, or
an acute alteration in mental status. Patients receiving inotropic or vasopressor
agents may not be hypotensive at the time that perfusion abnormalities are
measured.
General variables
Fever (core temperature >38.3°C)
Definite diagnosis
Hypothermia (core temperature <36°C)
Heart rate >90 /min or >2 SD above the normal value for age
Tachypnea Clinical picture consistent with tuberculosis; bacteriologic
Altered mental status
confirmation (culture, gene probe/NAA + AFB smear);
Significant edema or positive fluid balance (>20 mL/kg over 24 hrs)
Hyperglycemia (plasma glucose >120 mg/dL or 7.7 mmol/L) in the absence of histologic findings
diabetes
Inflammatory variables Probable diagnosis
Leukocytosis (WBC count >12,000 /mm3)
Leukopenia (WBC count <4000 /mm3)
Normal WBC count with >10% immature forms Clinical picture consistent with tuberculosis; exclusion of other
Plasma C-reactive protein >2 SD above the normal value
diagnostic considerations; presence of highly specific
Plasma procalcitonin >2 SD above the normal value
Hemodynamic variables
tuberculosis (surrogate) marker
Arterial hypotensionb (SBP <90 mm Hg, MAP <70, or an SBP decrease >40
mm Hg in adults or <2 SD below normal for age) Likely diagnosis
SvO2 >70%b
Cardiac index (CI) >3.5 L.min-1.M-23
Organ dysfunction variables Clinical picture consistent with tuberculosis; exclusion of other
Arterial hypoxemia (PaO2/FIO2 <300) diagnostic considerations; typical response to antituberculosis
Acute oliguria (urine output <0.5 mL.kg-1.hr-1 or 45 mmol/L for at least 2 hrs)
Creatinine increase >0.5 mg/dL
treatment (in absence of other treatment)
Coagulation abnormalities (INR >1.5 or aPTT >60 secs)
Ileus (absent bowel sounds) NOTE. AFB, acid-fast bacilli; NAA, nucleic acid amplification.
Thrombocytopenia (platelet count <100,000 /mm3)
Hyperbilirubinemia (plasma total bilirubin >4 mg/dL or 70 mmol/L)
Tissue perfusion variables
Hyperlactatemia (>4 mmol/L)
Decreased capillary refill or mottling
WBC, white blood cell; SBP, systolic blood pressure; MAP, mean arterial blood
pressure; SvO2, mixed venous oxygen saturation; INR, international normalized
ratio; aPTT, activated partial thromboplastin time.
aInfection defined as a pathologic process induced by a microorganism;
bSvO2 sat >70% is normal in children (normally, 75–80%), and CI 3.5–5.5 is normal
Positive criteria
Polycythemia Vera Study Group (PVSG) Diagnostic Criteria for 1. Sustained platelet count > 600x 109/l
Essential Thrombocytopaenia (ET) 2. Bone marrow biopsy specimen showing proliferation mainly of
the megakaryocytic lineage with increased numbers of
enlarged, mature megakaryocytes
All of the following criteria must be fulfilled to make a diagnosis of ET
Criteria of exclusion
1. Platelet count greater than 600 x 109/L
2. Hematocrit less than 40 or normal red blood cell mass
3. Stainable iron in the marrow or normal RBC mean corpuscular 1. No evidence of polycythaemia vera (PV)
volume (If these measurements suggest iron deficiency, Normal red cell mass or Hb <18.5 g/dl in men, 16.5g/dl in
polycythemia vera cannot be excluded unless a trial of iron women
therapy fails to increase the red blood cell mass into the Stainable iron in marrow, normal serum ferritin or normal
polycythemic range.) mean corpuscular volume (MCV)
4. No Philadelphia chromosome or bcr/abl gene rearrangement If the former is not met, failure of iron trial to increase red
5. Collagen fibrosis of the bone marrow absent or less than one cell mass or hemoglobin levels to the PV range
third of the biopsy area without both marked splenomegaly 2. No evidence of CML
and a leukoerythroblastic blood film No evidence of Philadelphia chromosome and no BCR/ABL
6. No cytogenetic or morphologic evidence for a myelodysplastic fusion gene
syndrome 3. No evidence of idiopathic myelofibrosis
7. No cause for a reactive thrombocytosis Collagen fibrosis absent
Reticulin fibrosis minimal or absent
4. No evidence of myelodysplastic syndrome
No del(5q), t(3;3)(q21;26),inv(3)(q21q26)
No significant granulocytic dysplasia; few, if any,
micromegakaryocytes
5. No evidence that thrombocytosis is reactive due to:
Underlying inflammation or infection
Underlying neoplasm
Prior splenectomy
CURB-65 and CRB-65 Severity Scores for Criteria for Acute Kidney Injury
Community-Acquired Pneumonia (CAP)
CRB-65 = Confusion, Respiratory rate, Blood pressure, 65 years of age and older.
GOLD Staging System for Chronic Obstructive
PSI/PORT Score: Pneumonia Severity Lung Disease (COPD) Severity
Index for CAP Definition
COPD is a disease state characterized by airflow limitation that is not fully
reversible. The airflow limitation is usually both progressive and associated with
an abnormal inflammatory response of the lungs to noxious particles or gases.
GOLD = Global Initiative for Chronic Obstructive Lung Disease; COPD = chronic
obstructive pulmonary disease; FEV1 = forced expiratory volume in one
second; FVC = forced vital capacity.
Global Initiative for Asthma (GINA)
Classification of Asthma Severity
PEF, Peak Expiratory Flow; FEV1, Forced Expiratory Volume in the first second.
• The presence of one of the features of severity is sufficient to place a patient
in that category.
• Patients at any level of severity-even intermittent asthma-can have severe
attacks.