Assign ACE-27

Assign Adult Comorbidity Evaluation-27 index based on 26 medical comorbidities.

assign_ace27(
  ace_mi,
  ace_cad,
  ace_chf,
  ace_arr,
  ace_htn,
  ace_vd,
  ace_pad,
  ace_res,
  ace_hep,
  ace_sto,
  ace_pan,
  ace_rd,
  ace_dm,
  ace_str,
  ace_dem,
  ace_par,
  ace_neu,
  ace_psy,
  ace_rhe,
  ace_aid,
  ace_st,
  ace_lm,
  ace_lym,
  ace_alc,
  ace_id,
  ace_obe,
  separate_nos = FALSE
)

Arguments

ace_mi

Myocardial Infarction

ace_cad

Angina / Coronary Heart Disease

ace_chf

Congestive Heart Failure

ace_arr

Arrhythmias

ace_htn

Hypertension

ace_vd

Venous Disease

ace_pad

Peripheral Arterial Disease

ace_res

Respiratory System

ace_hep

Hepatic

ace_sto

Stomach / Intestine

ace_pan

Pancreas

ace_rd

End-stage renal disease

ace_dm

Diabetes Mellitus

ace_str

Stroke

ace_dem

Dementia

ace_par

Paralysis

ace_neu

Neuromuscular

ace_psy

Psychiatric

ace_rhe

Rheumatologic

ace_aid

AIDS

ace_st

Solid Tumor including melanoma

ace_lm

Leukemia and Myeloma

ace_lym

Lymphoma

ace_alc

Alcohol

ace_id

Illicit Drugs

ace_obe

Obesity

separate_nos

logical; if TRUE, cases that only have "NOS" ailments (excluding Obesity, NOS) are separated into their own category.

Value

A factor with levels "None", ">=Mild", ">=Moderate", "Severe" (and "NOS" if separate_nos = TRUE) indicating the overall ACE-27 score.

Details

Each comorbidity is scored on a scale of Grades 0-3, where 0 = None, 1 = Mild, 2 = Moderate, and 3 = Severe. The ACE-27 overall score is assigned according to the highest ranked individual comorbidity recorded. However, if there are two or more Grade 2 comorbidities occuring in different organ systems, then the overall score becomes Grade 3.

When there is insufficient information regarding a comorbidity, then it is described as an "NOS" (not otherwise specified) case. There are two ways to handle these two cases. First, we can set separate_nos = TRUE to create a separate category of cases that only have NOS ailments, with "Obesity, NOS" being the exception as it is only assigned to Grade 2. Or, we can set separate_nos = FALSE and have the NOS cases be categorized with the lowest risk group based on information we have on all the ACE variables. Thus, we relabel "Mild" and "Moderate" to ">=Mild" and ">=Moderate" respectively to reflect the risk uncertainty.

Two other scoring assumptions are made. First, if there is insufficient information regarding a comorbidity then it is described as an "NOS" (not otherwise specified) case, and scored as Grade 1. To account for the possibility an NOS case is actually higher than Grade 1, all Grade 1/2 are relabelled with ">=". Alternatively, one can also specify separate_nos as TRUE to create a separate category of cases that only have NOS ailments, with "Obesity, NOS" being the exception as it is only assigned to Grade 2.

Any case with multiple symptoms from different Grades is scored into the higher Grade. For example, someone with symptoms from both Grade 1 and Grade 2 is categorized as Grade 2.

ACE comorbidities by organ systems

• Cardiovascular System

  • Myocardial Infarction

  • Angina / Coronary Heart Disease

  • Congestive Heart Failure

  • Arrhythmias

  • Hypertension

  • Venous Disease

  • Peripheral Arterial Disease

• Respiratory System

• Gastrointestinal System

  • Hepatic

  • Stomach / Intestine

  • Pancreas

• Renal System

  • End-stage renal disease

• Endocrine System

  • Diabetes Mellitus

• Neurological System

  • Stroke

  • Dementia

  • Paralysis

  • Neuromuscular

• Psychiatric

• Rheumatologic

• Immunological System

  • AIDS

• Malignancy

  • Solid Tumor including melanoma

  • Leukemia and Myeloma

  • Lymphoma

• Substance Abuse

  • Alcohol

  • Illicit Drugs

• Body Weight

  • Obesity

References

Binder PS, Peipert JF, Kallogjeri D, et al. Adult Comorbidity Evaluation 27 score as a predictor of survival in endometrial cancer patients. Am J Obstet Gynecol. 2016;215(6):766.e1-766.e9. doi:10.1016/j.ajog.2016.07.035

https://siog.org/files/public/ace27.pdf

Author

Derek Chiu