The APACHE II score is a general measure of disease severity, based on current physiologic measurements, age and previous health condition. The score can help in the assessment of patients to determine the level and degree of diagnostic and therapeutic intervention.
Components:
(1) acute physiology score (APS)
(2) age points
(3) chronic health points
Data collection:
(1) The data for the acute physiology is collected during the initial 24 hour period after ICU admission.
(2) The worst (most deranged) physiologic value is selected for grading.
Acute Physiology Score (APS)
|
Parameter |
Finding |
Points |
|---|---|---|
|
rectal temp in C° |
>= 41 |
+4 |
|
|
39-40.9 |
+3 |
|
|
38.5-38.9 |
+1 |
|
|
36-38.4 |
0 |
|
|
34-35.9 |
+1 |
|
|
32-33.9 |
+2 |
|
|
30-31.9 |
+3 |
|
|
<= 29.9 |
+4 |
|
mean arterial pressure mm Hg |
>= 160 |
+4 |
|
|
130-159 |
+3 |
|
|
110-129 |
+2 |
|
|
70-109 |
0 |
|
|
50-69 |
+2 |
|
|
<= 49 |
+4 |
|
heart rate in beats/minute |
>= 180 |
+4 |
|
|
140-179 |
+3 |
|
|
110-139 |
+2 |
|
|
70-109 |
0 |
|
|
55-69 |
+2 |
|
|
40-54 |
+3 |
|
|
<= 39 |
+4 |
|
respiratory rate in breaths/min |
>=50 |
+4 |
|
|
35-49 |
+3 |
|
|
25-34 |
+1 |
|
|
12-24 |
0 |
|
|
10-11 |
+1 |
|
|
6-9 |
+2 |
|
|
<= 5 |
+4 |
|
oxygenation |
A-aDO2 >= 500 and FIO2 >= 0.5 |
+4 |
|
|
A-aDO2 350-499 and FIO2 >= 0.5 |
+3 |
|
|
A-aDO2 200-349 and FIO2 >= 0.5 |
+2 |
|
|
A-aDO2 < 200 and FIO2 >= 0.5 |
0 |
|
|
PaO2 > 70 and FIO2 < 0.5 |
0 |
|
|
PaO2 61-70 and FIO2 < 0.5 |
+1 |
|
|
PaO2 55-60 and FIO2 < 0.5 |
+3 |
|
|
PaO2 < 55 and FIO2 < 0.5 |
+4 |
|
arterial pH |
>= 7.7 |
+4 |
|
|
7.6-7.69 |
+3 |
|
|
7.5-7.59 |
+1 |
|
|
7.33-7.49 |
0 |
|
|
7.25-7.32 |
+2 |
|
|
7.15-7.24 |
+3 |
|
|
< 7.15 |
+4 |
|
serum sodium |
>= 180 |
+4 |
|
|
160-179 |
+3 |
|
|
155-159 |
+2 |
|
|
150-154 |
+1 |
|
|
130-149 |
0 |
|
|
120-129 |
+2 |
|
|
111-119 |
+3 |
|
|
<= 110 |
+4 |
|
serum potassium |
>= 7.0 |
+4 |
|
|
6.0-6.9 |
+3 |
|
|
5.5-5.9 |
+1 |
|
|
3.5-5.4 |
0 |
|
|
3.0-3.4 |
+1 |
|
|
2.5-2.9 |
+2 |
|
|
< 2.5 |
+4 |
|
serum creatinine in mg/dL |
>= 3.5 and not acute renal failure |
+4 |
|
|
2.0-3.4 and not acute renal failure |
+3 |
|
|
1.5-1.9 and not acute renal failure |
+2 |
|
|
0.6-1.4 and not acute renal failure |
0 |
|
|
< 0.6 and not acute renal failure |
+2 |
|
|
>= 3.5 and acute renal failure |
+8 |
|
|
2.0-3.4 and acute renal failure |
+6 |
|
|
1.5-1.9 and acute renal failure |
+4 |
|
|
0.6-1.4 and acute renal failure |
0 |
|
|
< 0.6 and acute renal failure |
+4 |
|
hematocrit in percent |
>= 60 |
+4 |
|
|
50-59.9 |
+2 |
|
|
46-49.9 |
+1 |
|
|
30-45.9 |
0 |
|
|
20-29.9 |
+2 |
|
|
< 20 |
+4 |
|
WBC count in thousands |
>= 40 |
+4 |
|
|
20-39.9 |
+2 |
|
|
15-19.9 |
+1 |
|
|
3-14.9 |
0 |
|
|
1-2.9 |
+2 |
|
|
< 1 |
+4 |
|
Glasgow Coma Score |
|
15 - (Glasgow Coma Score) |
where:
• The score for serum creatinine is doubled if the patient has acute renal failure.
• mean arterial pressure =
= ((systolic blood pressure) + (2 * (diastolic pressure))) / 3
If no blood gas data is available, then the serum bicarbonate can be used (I assume in place of the arterial pH):
|
Parameter |
Finding |
Points |
|---|---|---|
|
serum bicarbonate in mmol/L |
>= 52.0 |
+4 |
|
|
41.0 – 51.9 |
+3 |
|
|
32.0 – 40.9 |
+1 |
|
|
22.0 – 31.9 |
0 |
|
|
18.0 – 21.9 |
+2 |
|
|
15.0 – 17.9 |
+3 |
|
|
< 15.0 |
+4 |
Age Points
|
Age |
Points |
|---|---|
|
<= 44 |
0 |
|
45-54 |
2 |
|
55-64 |
3 |
|
65-74 |
5 |
|
>= 75 |
6 |
Chronic Health Points
|
Operative Status |
Health Status |
Points |
|---|---|---|
|
nonoperative patient |
history of severe organ insufficiency OR immunocompromised |
5 |
|
|
no history of severe organ insufficiency AND immunocompetent |
0 |
|
emergency postoperative patient |
history of severe organ insufficiency OR immunocompromised |
5 |
|
|
no history of severe organ insufficiency AND immunocompetent |
0 |
|
elective postoperative patient |
history of severe organ insufficiency OR immunocompromised |
2 |
|
|
no history of severe organ insufficiency AND immunocompetent |
0 |
where:
• organ insufficiency or immunocompromised state must have preceded the current admission
• immunocompromised if: (1) receiving therapy reducing host defenses (immunosuppression, chemotherapy, radiation therapy, long term steroid use, high dose steroid therapy), or (2) has a disease severe enough to interfere with immune function such as malignant lymphoma, leukemia or AIDS
• liver insufficiency if: (1) biopsy proven cirrhosis, (2) portal hypertension, (3) episodes of upper GI bleeding due to portal hypertension, (4) prior episodes of hepatic failure, coma or encephalopathy
• cardiovascular insufficiency if: New York Heart Association Class IV
• respiratory insufficiency if: (1) severe exercise restriction due to chronic restrictive, obstructive or vascular disease, (2) documented chronic hypoxia, hypercapnia, secondary polycythemia, severe pulmonary hypertension, (3) respirator dependency
• renal insufficiency if: on chronic dialysis
APACHE II score =
= (acute physiology score) + (age points) + (chronic health points)
Interpretation:
• minimum score: 0
• maximum score: 71
• An increasing score is associated with an increasing risk of hospital death.
Purpose: To assess a hospitalized patient for severity of disease using the APACHE II score.
Specialty: Critical Care, Emergency Medicine
Objective: severity, prognosis, stage, disease progression
ICD-10: R57,
