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      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    Veterans Aging Cohort Study (VACS) Index

    Estimates risk of 5-year all-cause mortality in patients with HIV and/or HCV.
    When to Use
    Pearls/Pitfalls
    Why Use

    Aids in prognostication in patients with HIV or Hepatitis C. Potentially useful with goals of care planning or aggressiveness of therapy.

    • The VACS Index comes from a US VA population, so most patients in both the derivation and validation cohorts were men.
    • Half of patients had started anti-retrovirals prior to 2004, so it is unknown how the newer anti-retrovirals may affect these estimates.
    • <5% of patients in this study were ≥65 years old so this is likely less accurate in older populations.
    • Few patients in the study had significant renal disease: >90% had an eGFR ≥60.

    Traditional mortality estimates using only viral load or CD4 count in HIV or FIB-4 in Hepatitis C are inaccurate; the VACS Index looks adds additional markers to estimate multi-organ system involvement and more-accurately predict mortality.

    < 50 years
    0
    50 - 64 years
    +12
    ≥ 65 years
    +27
    ≥ 500 cells/mm³
    0
    350 - 499 cells/mm³
    +6
    200 - 349 cells/mm³
    +6
    100 - 199 cells/mm³
    +10
    50 - 100 cells/mm³
    +28
    < 50 cells/mm³
    +29
    < 500 copies/mL
    0
    500 - 99,999 copies/mL
    +7
    ≥ 1x10⁵ copies/mL
    +14
    ≥ 14 g/dL
    0
    12 - 13.9 g/dL
    +10
    10 - 11.9 g/dL
    +22
    <10 g/dL
    +38
    < 1.45
    0
    1.45 - 3.25
    +6
    > 3.25
    +25
    ≥ 60 mL/min
    0
    45 - 59.9 mL/min
    +6
    30 - 44.9 mL/min
    +8
    < 30 mL/min
    +26
    No
    0
    Yes
    +5

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Amy Justice

    About the Creator

    Amy Justice, MD, PhD, is the CNH Long Professor of Medicine and of Public Health at Yale University and a Staff Physician at the VA Connecticut Healthcare System. As principal investigator of the Veterans Aging Cohort Study (VACS), she has more than 20 years of experience developing and validating predictive indices using electronic health record data.

    To view Dr. Amy Justice's publications, visit PubMed

    Are you Dr. Amy Justice? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Amy Justice
    Are you Dr. Amy Justice?