Comorbidity: a Modern View on the Problem; Classification (second notice)

Abstract

Introduction. The problem of classification of comorbid diseases is very actual now. Despite this fact, the search for the new variants of combinations of the diseases continues, as their combinations can simply be not yet classified syndromal diseases, or vice versa – to be completely incompatible for the appearance and coexistence in one body. This is the key to solve more and more problems for the diagnosis and treatment of the diseases in the field of the practical medicine. That is why a comprehensive study and detailed systematization of the knowledge with our attempt to create the unified classification of the comorbidities are important steps towards the understanding and solving this problem. Aim. To analyze the literature sources dealing with the study of comorbid diseases and present the modern views of the scientists in relation to these problems in order to unify it. Materials and methods. The work analyzes the literature sources, which deal with the study of comorbid diseases and quite thoroughly reflect the current views of the scientists on this issue, based on which was made a systematization of the received facts and was proposed our own classification. Results. Comorbidity is one of the main problems in modern medicine. But, organizing theoretical and practical knowledge of comorbid diseases, and thus solving the problem as a whole, unfortunately, does not go beyond the scientific debate, about which there is still no coherent understanding of its essence and unification of the used terminology. For standardization of the scientific researches on comorbidity as a random combination of the diseases in one patient, which are different by their etiology and pathogenesis such as nosological syntropy, i.e. natural occurrence of the regular determined diseases combinations, were proposed 12 indices and one simple list of the diseases. It is suggested that all the diseases that occur in the body are divided into monodisease (only one uncomplicated disease in one person) and comorbid disease (2 or more diseases in one person), which, in its turn, are divided into columns, depending on the amount of the diseases, their etiology, сlinical variant of the lesions, relationship between the diseases combined in one body, their origin, the presence of morphological changes, involvement of organs and systems into the process, the order of their appearance, symptomatical dominance, the presence of the complications, prognosis and so on. Conclusions. The given classification is important for the applied medicine, as it can help the doctor to organize and comprehensively assess the disease, to scale the level of injuring of the certain organs or organ systems by the pathological process, the mode of the diseases, the possibility or, conversely, illogicality of the causal connection between them, and then conduct all necessary diagnostic procedures according to their importance for the diagnosis, prescribe treatment without recourse to polypharmacy and get a positive result of this treatment.

Keywords

• classification
• comorbid diseases
• polymorbidity
• syntropy