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ICU Scores: Acute Physiology & Chronic Health Evaluation (APACHE II):

APACHE II: a severity of disease classification system.

Crit Care Med. 1985 Oct;13(10):818-29
Knaus WA, Draper EA, Wagner DP, Zimmerman JE.

This paper presents the form and validation results of APACHE II, a severity of disease classification system. APACHE II uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status to provide a general measure of severity of disease. An increasing score (range 0 to 71) was closely correlated with the subsequent risk of hospital death for 5815 intensive care admissions from 13 hospitals. This relationship was also found for many common diseases. When APACHE II scores are combined with an accurate description of disease, they can prognostically stratify acutely ill patients and assist investigators comparing the success of new or differing forms of therapy. This scoring index can be used to evaluate the use of hospital resources and compare the efficacy of intensive care in different hospitals or over time.

APACHE II Calculator

  • Enter the lowest and the highest values for the physiologic parameter
  • Use the worse values during the 24 hour period
Select the Unit:
STD UnitsSI Units
Lowest
Highest
Lowest Highest
Temperature :
°F°C
Sodium (mmol/L)
Systolic B/P (mm Hg):
Potassium (mmol/L)
Diastolic B/P (mm Hg):
Creatinine
Heart Rate (/m):
Acute Renal Failure (definition)
Respiratory Rate (/m):
HCT (%)
Altitude above sea level:
FeetMeter
WBC (x103/ mm3 )
Fio2 (%):
Glasgow Coma Score
(calculate)
PH:
AGE
PO2:
Chronic Organ Failure: (definition)
PCO2:
HCO3 (mmol/L):
APACHE Score 
Predicted Mortality Rate

Acute renal failuere is defined as a sudden increase in creatinine with urine output less than 185 ml/8 hours :

Up to APACHE

Glascow Coma Score

Eyes Opening

Verbal Response

Motor Response

spontaneous
to speech
to pain
absent

converses & oriented
converses & dsoriented
iappropriate
incomprehensible
absent

obeys
localizes pain
withdraws (flexion)
decorticate (flexion) rigidity
decerebrate (extension) rigidity
absent

Glasgow Coma Score=

Up to APACHE II

*Chronic Organ Failure/Immune Deficiency Definitions: APACHE II

Liver insufficiency

Cardiovascular

Respiratory

Renal

Immuno-depression

Biopsy proven cirrhosis
Documented portal hypertension,
Episodes of past upper GI bleeding attributed to portal hypertension
Prior episodes of hepatic failure / encephalopathy / coma.

NYHA Class IV

Chronic restrictive, obstructive or vascular disease resulting in severe exercice restriction, i.e. unable to climb stairs or perform household duties.
Documented chronic hypoxia, hypercapnia, secondary polycythemia , severe pulmonary hypertension (> 40 mmHg), or respirator dependency.

Receiving chronic dialysis

The patient has received therapy that suppresses resistance to infection e.g. immuno-suppression, chemotherapy, radiation, long term or recent hight dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g. leukemia, lymphoma, AIDS.

ICU Scores APACHE II SAPS II MPM-0 MPM-24 MPM-48 MPM-Over Time SOFA MODS PRISM

References:

Recent innovations in intensive care unit risk-prediction models.
Curr Opin Crit Care. 2002 Aug;8(4):321-30. Review.

Assessment of six mortality prediction models in patients admitted with severe sepsis and septic shock to the intensive care unit: a prospective cohort study.
Crit Care. 2003 Oct;7(5):R116-22. Epub 2003 Aug 28.

Intensive Care Society's Acute Physiology and Chronic Health Evaluation (APACHE II) study in Britain and Ireland: a prospective, multicenter, cohort study comparing two methods for predicting outcome for adult intensive care patients.
Crit Care Med. 1994 Sep;22(9):1392-401.

Scoring systems in the intensive care unit
Anaesthesist. 2003 Oct;52(10):965-87; quiz 988-9. Review. German.

Rating the quality of intensive care units: is it a function of the intensive care unit scoring system?
Crit Care Med. 2002 Sep;30(9):1976-82.

Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II.
Respir Care. 1995 Oct;40(10):1042-7. Review.

Predicting outcome in critical care: the current status of the APACHE prognostic scoring system.
Can J Anaesth. 1991 Apr;38(3):374-83. Review

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