Oncology

CIRS-G Calculator (Cumulative Illness Rating Scale — Geriatric)

Cumulative severity across 14 organ systems (0-4 each)

Primary source: Miller MD, Paradis CF et al. J Am Geriatr Soc 1992; 40(6): 622-627

Aleksandr A. Aulov, MD, internal medicine Last clinical review: April 28, 2026

Online calculation

Heart

Vessels (including hypertension)

Hematologic (excluding leukemia)

Respiratory

Eyes, ears, nose, throat

Upper GI

Lower GI

Liver

Kidneys

Genitourinary (excluding metastases)

Musculoskeletal

Neurological

Endocrine/metabolic

Psychiatric disorders

About this score

CIRS-G (Cumulative Illness Rating Scale — Geriatric, Miller MD. et al., Psychiatry Res 1992) is a detailed geriatric comorbidity assessment across 14 organ systems. Each system is scored 0–4: 0 = no problem; 1 = mild; 2 = moderate, symptomatic; 3 = severe, disabling; 4 = extremely severe, life-threatening.

Systems: heart, hypertension, vessels, respiratory, ENT/eye, upper GI, lower GI, liver, kidneys, genitourinary, musculoskeletal/skin, neurological, endocrine/metabolic, psychiatric. Total score range 0–56 (14 categories, each scored up to a maximum of 4 points).

Used for comprehensive assessment in geriatrics, oncology, and clinical research. Particularly relevant in CLL: first-line treatment selection in older patients partly relies on CIRS — the "GO-GO" category (CIRS ≤ 6, no critical organ deficits) versus "SLOW-GO" (moderate comorbidity) versus "NO-GO" (severe polymorbidity). Used internationally, including by ESMO, as an alternative or complement to the Charlson index.

When to use

Comprehensive geriatric assessment of older adults.
First-line treatment selection in hematologic oncology (CLL, lymphomas, acute leukemias in older patients).
Stratification in clinical trials.
Predicting tolerance of intensive therapy and surgical interventions.

Clinical example

Case

75-year-old woman with CLL. Comorbidities: controlled stage 2 hypertension (hypertension — 2), stable CAD, NYHA class II (heart — 2), operated cataract (eyes/ENT — 1), varicose vein disease (vessels — 1), CKD G3a (kidneys — 2), osteoarthritis (musculoskeletal — 2), mild depression (psychiatric — 1).

Calculation

Heart 2 + hypertension 2 + vessels 1 + eyes/ENT 1 + kidneys 2 + musculoskeletal 2 + psychiatric 1 + remaining systems 0 = 11 points.

Interpretation and management

Moderate comorbidity (CIRS 11), "SLOW-GO" category. In the context of CLL — candidate for BTK inhibitors or venetoclax plus obinutuzumab (preferred over chemoimmunotherapy). Parallel assessment of ECOG, functional reserve (6-minute walk test), and regimen selection accounting for reduced renal function and cardiovascular profile.

Limitations and cautions

Cumbersome (14 systems) — takes 15–20 minutes to complete.
Subjective grading of severity within each system.
Does not directly capture functional status (ECOG/KPS assessed in parallel).
Low uptake in general internal medicine practice; used mainly in specialized centers.

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Frequently asked questions

CIRS vs Charlson — which to choose?

Charlson is shorter and better suited for survival prognosis. CIRS is more detailed and better suited for comprehensive geriatric assessment and oncologic treatment selection in older adults.

What counts as the "GO-GO" category in hematology?

Typically CIRS ≤ 6 points with no category scored 3–4, plus ECOG 0–1 and GFR ≥ 70. These patients tolerate intensive chemoimmunotherapy.

Does CIRS change during treatment?

It can — for example, chemotherapy toxicity adds points across several systems. Reassess every 3–6 months.

Is it applicable in younger patients?

The scale has a specific geriatric modification (-G), but the base CIRS applies at any age.

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Aleksandr A. Aulov Physician, internal medicine, Sechenov School — independent medical education platform. Calculators are compiled from the original publications and current clinical guidelines. Interpretation thresholds follow the source study unless stated otherwise.

This calculator is intended for healthcare professionals. Do not use it for self-diagnosis or self-treatment. Management decisions are made by the treating clinician based on the full clinical picture of the individual patient.