Acute Physiology and Chronic Health Evaluation

Aka: Acute Physiology and Chronic Health Evaluation, APACHE Score

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II. Background

  1. This page documents the APACHE 2 Score for historical purposes and for a general look overview of criteria
  2. APACHE 4 has replaced the APACHE 2 Score and is best performed via calculators
    1. Ko (2018) Acute Crit Care 33(4):216-21 +PMID: 31723888 [PubMed]
  3. APACHE 4 Calculator: Intensive Care network calculator
    1. https://intensivecarenetwork.com/Calculators/Files/Apache4.html

III. Indications

  1. Assess disease severity in Intensive Care unit patients (age >16 years old)

IV. Technique

  1. Calculate APACHE 2 score in the first 24 hours of ICU admission

V. Criteria: Rectal Temperature

  1. Score 4: Temperature > 41
  2. Score 3: Temperature 39 to 40.9
  3. Score 1: Temperature 38.5 to 38.9
  4. Score 0: Temperature 36 to 38.4
  5. Score 1: Temperature 34 to 35.9
  6. Score 2: Temperature 32 to 33.9
  7. Score 3: Temperature 30 to 31.9
  8. Score 4: Temperature <29.9

VI. Criteria: Mean arterial pressure (MAP)

  1. Score 4: Mean arterial pressure 160 mmHg or greater
  2. Score 3: Mean arterial pressure 130 to 159 mmHg
  3. Score 2: Mean arterial pressure 110 to 129 mmHg
  4. Score 0: Mean arterial pressure 70 to 109 mmHg
  5. Score 2: Mean arterial pressure 50 to 69 mmHg
  6. Score 4: Mean arterial pressure 49 mmHg or less

VII. Criteria: Heart Rate

  1. Score 4: Heart Rate 180 per minute or greater
  2. Score 3: Heart Rate 140 to 179 per minute
  3. Score 2: Heart Rate 110 to 139 per minute
  4. Score 0: Heart Rate 70 to 109 per minute
  5. Score 2: Heart Rate 55 to 69 per minute
  6. Score 3: Heart Rate 40 to 54 per minute
  7. Score 4: Heart Rate 39 per minute or less

VIII. Criteria: Respiratory Rate

  1. Score 4: Respiratory Rate 50 per minute or greater
  2. Score 3: Respiratory Rate 35 to 49 per minute
  3. Score 1: Respiratory Rate 25 to 34 per minute
  4. Score 0: Respiratory Rate 12 to 24 per minute
  5. Score 1: Respiratory Rate 10 to 11 per minute
  6. Score 2: Respiratory Rate 6 to 9 per minute
  7. Score 4: Respiratory Rate 5 per minute or less

IX. Criteria: A-a Gradient or PaO2

  1. Score 4: A-a Gradient 500 mmHg or greater (if on FIO2 >50%)
  2. Score 3: A-a Gradient 350 to 499 mmHg (if on FIO2 >50%)
  3. Score 2: A-a Gradient 200 to 349 mmHg (if on FIO2 >50%)
  4. Score 0: A-a Gradient <200 mmHg (if on FIO2 >50%) or PaO2 >70 mmHg (if on FIO2 <50%)
  5. Score 1: PaO2 61 to 70 mmHg (if on FIO2 <50%)
  6. Score 3: PaO2 55 to 60 mmHg (if on FIO2 <50%)
  7. Score 4: PaO2 55 mmHg or less (if on FIO2 <50%)

X. Criteria: Arterial pH or Bicarbonate (HCO3-)

  1. Score 4: Arterial pH 7.7 or Bicarbonate 52 or greater
  2. Score 3: Arterial pH 7.6 to 7.69 or Bicarbonate 41 to 51.9
  3. Score 1: Arterial pH 7.5 to 7.59 or Bicarbonate 32 to 40.9
  4. Score 0: Arterial pH 7.33 to 7.49 or Bicarbonate 23 to 31.9
  5. Score 2: Arterial pH 7.25 to 7.32 or Bicarbonate 18 to 22.9
  6. Score 3: Arterial pH 7.15 to 7.24 or Bicarbonate 15 to 17.9
  7. Score 4: Arterial pH <7.15 or Bicarbonate <15

XI. Criteria: Serum Sodium (Na+)

  1. Score 4: Serum Sodium 180 meq/L or greater
  2. Score 3: Serum Sodium 160 to 179 meq/L
  3. Score 2: Serum Sodium 155 to 159 meq/L
  4. Score 1: Serum Sodium 150 to 154 meq/L
  5. Score 0: Serum Sodium 30 to 149 meq/L
  6. Score 2: Serum Sodium 120 to 129 meq/L
  7. Score 3: Serum Sodium 111 to 119 meq/L
  8. Score 4: Serum Sodium 110 meq/L or less

XII. Criteria: Serum Potassium (K+)

  1. Score 4: Serum Potassium 7 meq/L or greater
  2. Score 3: Serum Potassium 6 to 6.9 meq/L
  3. Score 1: Serum Potassium 5.5 to 5.9 meq/L
  4. Score 0: Serum Potassium 3.5 to 5.4 meq/L
  5. Score 1: Serum Potassium 3 to 3.4 meq/L
  6. Score 2: Serum Potassium 2.5 to 2.9 meq/L
  7. Score 4: Serum Potassium <2.5 meq/L

XIII. Criteria: Serum Creatinine

  1. Score 8: Serum Creatinine 3.5 mg/dl or higher AND Acute Renal Failure
  2. Score 4: Serum Creatinine 3.5 mg/dl or higher
  3. Score 6: Serum Creatinine 2 to 3.4 mg/dl AND Acute Renal Failure
  4. Score 3: Serum Creatinine 2 to 3.4 mg/dl
  5. Score 4: Serum Creatinine 1.5 to 1.9 mg/dl AND Acute Renal Failure
  6. Score 2: Serum Creatinine 1.5 to 1.9 mg/dl
  7. Score 0: Serum Creatinine 0.6 to 1.4 mg/dl
  8. Score 2: Serum Creatinine <0.6 mg/dl

XIV. Criteria: Hematocrit

  1. Score 4: Hematocrit 60% or greater
  2. Score 2: Hematocrit 50 to 59.9%
  3. Score 1: Hematocrit 46 to 49.9%
  4. Score 0: Hematocrit 30 to 45.9%
  5. Score 2: Hematocrit 20 to 29.9%
  6. Score 4: Hematocrit <20%

XV. Criteria: White Blood Cell Count (WBC)

  1. Score 4: White Blood Cell Count 40 * 10^3/mm3 or higher
  2. Score 2: White Blood Cell Count 20 to 39.9 * 10^3/mm3
  3. Score 1: White Blood Cell Count 15 to 19.9 * 10^3/mm3
  4. Score 0: White Blood Cell Count 3 to 14.9 * 10^3/mm3
  5. Score 2: White Blood Cell Count 1 to 2.9 * 10^3/mm3
  6. Score 4: White Blood Cell Count <1 * 10^3/mm3

XVI. Criteria: Glasgow Coma Scale (GCS)

  1. Score = GCS - 15

XVII. Criteria: Age

  1. Score 6: Age 75 years or older
  2. Score 5: Age 65 to 74 years
  3. Score 3: Age 55 to 64 years
  4. Score 2: Age 45 to 54 years
  5. Score 0: Age 44 years or younger

XVIII. Criteria: Comorbidity

  1. Severe chronic health problems (one or more)
    1. Cirrhosis (confirmed by biopsy)
    2. Severe Congestive Heart Failure (NYHA Class 4)
    3. Severe COPD (hypercapnia, home oxygen or Pulmonary Hypertension >40 mmHg)
    4. End-stage renal disease on regularly scheduled Dialysis
    5. Immunocompromised
  2. Score 0: No severe comorbidities (from list above)
  3. Score 5: Medical (non-operative status) and one or more severe comorbidities
  4. Score 5: Post-operative status for emergent surgery and one or more severe comorbidities
  5. Score 2: Post-operative status for elective surgery and one or more severe comorbidities

XIX. Interpretation

  1. Total Score: 0 to 4
    1. Non-operative status: 4% mortality
    2. Post-operative status: 1% mortality
  2. Total Score: 5 to 9
    1. Non-operative status: 8% mortality
    2. Post-operative status: 3% mortality
  3. Total Score: 10-14
    1. Non-operative status: 15% mortality
    2. Post-operative status: 7% mortality
  4. Total Score: 15-19
    1. Non-operative status: 24% mortality
    2. Post-operative status: 12% mortality
  5. Total Score: 20-24
    1. Non-operative status: 40% mortality
    2. Post-operative status: 30% mortality
  6. Total Score: 25-29
    1. Non-operative status: 55% mortality
    2. Post-operative status: 35% mortality
  7. Total Score: 30-34
    1. Non-operative status: 73% mortality
    2. Post-operative status: 73% mortality
  8. Total Score: 35-100
    1. Non-operative status: 85% mortality
    2. Post-operative status: 88% mortality

XX. References

  1. Knaus (1985) Crit Care Med 13(10): 818–29 [PubMed]

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