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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

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]

Created: Mar 13, 2007
Last Modified: 03/13/2007