|
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 |
|
