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The APACHE II Severity of Disease Classification System

Physiologic Variable

High Abnormal Range                                                      Low Abnormal Range

 

+4

+3

+2

+1

0

+1

+2

+3

+4

Points

Temperature - rectal (C)

>41

39 to 40.9

 

38.5 to 38.9

36 to 38.4

34 to 35.9

32 to 33.9

30 to 31.9

<29.9

 

Mean Arterial Pressure - mm Hg

>160

130 to 159

110 to 129

 

70 to 109

 

50 to 69

 

<49

 

Heart Rate (ventricular response)

>180

140 to 179

110 to 139

 

70 to 109

 

55 to 69

40 to 54

<39

 

Respiratory Rate

(non-ventilated or ventilated)

>50

35 to 49

 

25 to 34

12 to 24

10 to 11

6 to 9

 

<5

 

Oxygenation: A-aDO2 or PaO2 (mm Hg)

a. FIO2 >0.5 record A-aDO2

b. FIO2 <0.5 record PaO2

>500

350 to 499

200 to 349

 

<200

 

 

 

 

PO2>70

 

 

 

 

 

PO2 61 to 70

 

 

 

 

 

 

PO2 55 to 60

 

 

 

 

 

PO2<55

 

Arterial pH (preferred)

 

Serum HCO3 (venous mEq/l)

(not preferred, but may use if no ABGs)

>7.7

 

 

>52

7.6 to 7.69

 

41 to 51.9

 

7.5 to 7.59

 

32 to 40.9

7.33 to 7.49

 

22 to 31.9

 

7.25 to 7.32

 

18 to 21.9

7.15 to 7.24

 

15 to 17.9

<7.15

 

 

<15

 

Serum Sodium (mEq/l)

>180

160 to 179

155 to 159

150 to 154

130 to 149

 

120 to 129

111 to 119

<110

 

Serum Potassium (mEq/l)

>7

6 to 6.9

 

5.5 to 5.9

3.5 to 5.4

3 to 3.4

2.5 to 2.9

 

<2.5

 

Serum Creatinine (mg/dl)

Double point score for acute renal failure

>3.5

2 to 3.4

1.5 to 1.9

 

0.6 to 1.4

 

<0.6

 

 

 

Hematocrit (%)

>60

 

50 to 59.9

46 to 49.9

30 to 45.9

 

20 to 29.9

 

<20

 

White Blood Count (total/mm3)

(in 1000s)

>40

 

20 to 39.9

15 to 19.9

3 to 14.9

 

1 to 2.9

 

<1

 

Glasgow Coma Score (GCS)

Score = 15 minus actual GCS

 

 

 

 

 

 

 

 

 

 

A. Total Acute Physiology Score (sum of 12 above points)

 

B. Age points (years) <44=0; 45 to 54=2; 55 to 64=3; 65 to 74=5; >75=6

 

C. Chronic Health Points (see below)

 

Total APACHE II Score (add together the points from A+B+C)

 

Chronic Health Points: If the patient has a history of severe organ system insufficiency or is immunocompromised as defined below, assign points as follows:

5 points for nonoperative or emergency postoperative patients

2 points for elective postoperative patients

Definitions: organ insufficiency or immunocompromised state must have been evident prior to this hospital admission and conform to the following criteria:

  • Liver biopsy proven cirrhosis and documented portal hypertension; episodes of past upper GI bleeding attributed to portal hypertension; or prior episodes of hepatic failure/encephalopathy/coma.
  • Cardiovascular New York Heart Association Class IV.
  • Respiratory Chronic restrictive, obstructive, or vascular disease resulting in severe exercise restriction (i.e., unable to climb stairs or perform household duties; or documented chronic hypoxia, hypercapnia, secondary polycythemia, severe pulmonary hypertension (>40 mmHg), or respirator dependency.
  • Renal receiving chronic dialysis.
  • Immunocompromised the patient has received therapy that suppresses resistance to infection (e.g., immunosuppression, chemotherapy, radiation, long term or recent high dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g., leukemia, lymphoma, AIDS).

Interpretation of Score:

Score

Death Rate (%)

0-4

4

5-9

8

10-14

15

15-19

25

20-24

40

25-29

55

30-34

75

>34

85

 

 

Related Criteria

Definitions for the Terms Bacteremia, Sepsis, Severe Sepsis, Septic Shock, and Other Related Disorders

Diagnostic Criteria for Disseminated Intravascular Coagulation (DIC)

Diagnostic Criteria for Adult Respiratory Distress Syndrome (ARDS)

More...

References:

  1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985 Oct;13(10):818-29  [Medline]

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Created: Mar 13, 2007
Last Modified: 10/24/2010

 
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