Ocular (either eye, by clinical assessment)
|
Any cataract ever
|
1
|
Retinal change or optic atrophy
|
1
|
Neuropsychiatric
|
Cognitive impairment (e.g. memory deficit, difficulty with
calculation, poor concentration, difficulty in spoken or written
language, impaired performance levels) or major psychosis
|
1
|
Seizures requiring therapy for 6 months
|
1
|
Cerebrovascular accident ever (score 2 if > 1)
|
1 (2)
|
Cranial or peripheral neuropathy (excluding optic)
|
1
|
Transverse myelitis
|
1
|
Renal
|
Estimated or measured glomerular filtration rate<50%
|
1
|
Proteinuria ≥3.5 gm/24hours
|
1
|
Or
|
End-stage renal disease (regardless of dialysis or transplantation)
|
3
|
Pulmonary
|
Pulmonary hypertension (right ventricular prominence, or loud P2)
|
1
|
Pulmonary fibrosis (physical and radiograph)
|
1
|
Shrinking lung (radiograph)
|
1
|
Pleural fibrosis (radiograph)
|
1
|
Pulmonary infarction (radiograph)
|
1
|
Cardiovascular
|
Angina or coronary artery bypass
|
1
|
Myocardial infarction ever (score 2 if > 1)
|
1 (2)
|
Cardiomyopathy (ventricular dysfunction)
|
1
|
Valvular disease (diastolic murmur, or systolic murmur >3/6)
|
1
|
Pericarditis for 6 months, or pericardiectomy
|
1
|
Peripheral vascular
|
Claudication for 6 months
|
1
|
Minor tissue loss (pulp space)
|
1
|
Significant tissue loss ever (e.g. loss of digit or limb)(score 2 if > 1 site)
|
1 (2)
|
Venous thrombosis with swelling, ulceration, or venous stasis
|
1
|
Gastrointestinal
|
Infarction or resection of bowel below duodenum spleen, liver, or gall bladder ever, for cause any (score 2 if > 1 site)
|
1 (2)
|
Mesenteric insufficiency
|
1
|
Chronic peritonitis
|
1
|
Stricture or upper gastrointestinal tract surgery ever
|
1
|
Musculoskeletal
|
Muscle atrophy or weakness
|
1
|
Deforming or erosive arthritis (including reducible deformities, excluding avascular necrosis)
|
1
|
Osteoporosis with fracture or vertebral collapse (excluding avascular necrosis)
|
1
|
Avascular necrosis (score 2 if > 1)
|
1 (2)
|
Osteomyelitis
|
1
|
Skin
|
Scarring chronic alopecia
|
1
|
Extensive scarring or panniculum other than scalp and pulp space
|
1
|
Skin ulceration (excluding thrombosis) for > 6 months
|
1
|
Premature gonadal failure
|
1
|
Diabetes (regardless of treatment)
|
1
|
Malignancy (exclude dysplasia) (score 2 if > 1 site)
|
1 (2)
|