_id

683a15fdc782e11e38d1b102

id

1868

title

APACHE II Score

full_title

APACHE II Score

short_title

APACHE II Score

med_description

Estimates ICU mortality.

short_description

Estimates ICU mortality.

slug

apache-ii-score

description

The Apache II Score estimates ICU mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account.

keywords

apache score, apache ii score, apache 2 score, apache calc, apache ii calc, apache 2 calc, apache ICU score, apache ICU calc, apache mortality estimate, apache mortality, apache mortality calc, ICU mortality calc, icu mortality estimate, icu apache, intensive apache, intensive mortality estimate, intensive mortality calc, intensive mortality score

complaint

[ "Fever" ]

formula

Addition of the selected points; points assigned below:

evidence

• The APACHE II score was initially presented and validated in this study by Knaus et al. that prospectively enrolled 5815 patients from 13 hospitals. Complete data on all 12 physiologic measurements was only available for 5030 patients. The APACHE II score was shown to have good prognostic value in acutely ill patients.
• This study prospectively validated the APACHE II score in 1721 consecutively admitted patients in a single center. The area under the ROC curve was higher than 0.8. The patient population was mostly comprised of surgical patients however.

measurements

[ { "name": "Age", "unit": "age", "error_min": "0.001", "error_max": "120", "warn_min": "0.1", "warn_max": "100", "conversion": "1", "normal_max_si": "0", "normal_max_us": "0", "normal_min_si": "0", "normal_min_us": "0", "units_si": "years", "units_us": "years" }, { "name": "Creatinine", "unit": "cr", "error_min": "0.01", "error_max": "40", "warn_min": "0", "warn_max": "10", "conversion": "88.4", "normal_max_si": "115", "normal_max_us": "1.3", "normal_min_si": "62", "normal_min_us": "0.7", "units_si": "µmol/L", "units_us": "mg/dL" }, { "name": "Hematocrit", "unit": "hct", "error_min": "1", "error_max": "70", "warn_min": "20", "warn_max": "55", "conversion": "1", "normal_max_si": "51", "normal_max_us": "51", "normal_min_si": "36", "normal_min_us": "36", "units_si": "%", "units_us": "%" }, { "name": "Respiratory Rate", "unit": "rr", "error_min": "0", "error_max": "90", "warn_min": "5", "warn_max": "70", "conversion": "1", "normal_max_si": "20", "normal_max_us": "20", "normal_min_si": "12", "normal_min_us": "12", "units_si": "breaths/min", "units_us": "breaths/min" }, { "name": "Sodium", "unit": "na", "error_min": "100", "error_max": "200", "warn_min": "0", "warn_max": "170", "conversion": "1", "normal_max_si": "145", "normal_max_us": "145", "normal_min_si": "136", "normal_min_us": "136", "units_si": "mmol/L", "units_us": "mEq/L" }, { "name": "Glasgow Coma Scale", "unit": "gcs", "error_min": "3", "error_max": "16", "warn_min": "3", "warn_max": "15", "conversion": "1", "normal_max_si": "15", "normal_max_us": "15", "normal_min_si": "3", "normal_min_us": "3", "units_si": "points", "units_us": "points" }, { "name": "Heart Rate/Pulse", "unit": "hr", "error_min": "10", "error_max": "300", "warn_min": "20", "warn_max": "200", "conversion": "1", "normal_max_si": "100", "normal_max_us": "100", "normal_min_si": "60", "normal_min_us": "60", "units_si": "beats/min", "units_us": "beats/min" }, { "name": "pH", "unit": "ph", "error_min": "6.2", "error_max": "8.5", "warn_min": "7", "warn_max": "7.6", "conversion": "1", "normal_max_si": "7.44", "normal_max_us": "7.44", "normal_min_si": "7.38", "normal_min_us": "7.38", "units_si": "", "units_us": "" }, { "name": "Temperature", "unit": "temp", "error_min": "70", "error_max": "120", "warn_min": "90", "warn_max": "108", "conversion": "var C, F; if (C) { (C * 9/5)+32; } else { (F -32) * 5/9; } ", "normal_max_si": "37.8", "normal_max_us": "100", "normal_min_si": "36.1", "normal_min_us": "97", "units_si": "C", "units_us": "F" }, { "name": "Potassium", "unit": "k", "error_min": "1", "error_max": "10", "warn_min": "2", "warn_max": "7", "conversion": "1", "normal_max_si": "5.2", "normal_max_us": "5.2", "normal_min_si": "3.5", "normal_min_us": "3.5", "units_si": "mmol/L", "units_us": "mEq/L" }, { "name": "Mean Arterial Pressure", "unit": "map", "error_min": "15", "error_max": "210", "warn_min": "40", "warn_max": "180", "conversion": "1", "normal_max_si": "100", "normal_max_us": "100", "normal_min_si": "70", "normal_min_us": "70", "units_si": "mm Hg", "units_us": "mm Hg" }, { "name": "White Blood Cell Count", "unit": "wbc", "error_min": "0.0001", "error_max": "500", "warn_min": "1.5", "warn_max": "100", "conversion": "1", "normal_max_si": "10.7", "normal_max_us": "10.7", "normal_min_si": "3.7", "normal_min_us": "3.7", "units_si": "× 10⁹ cells/L", "units_us": "× 10³ cells/µL" } ]

information

The APACHE-II Score provides an estimate of ICU mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account. Note: The data used should be from the initial 24 hours in the ICU, and the worst value (further from baseline/normal) should be used.

The following defines “chronic organ insufficiency” and immunocompromise:

• Liver insufficiency
  • Biopsy proven cirrhosis
  • Documented portal hypertension
  • Episodes of past upper GI bleeding attributed to portal hypertension
  • Prior episodes of hepatic
• Cardiovascular
  • New York Heart Association Class IV Heart Failure
• Respiratory
  • Chronic restrictive, or vascular disease resulting in severe exercice restriction, i.e. unable to climb stairs or perform household duties
  • Documented chronic hypoxia, hypercapnia, secondary severe pulmonary hypertension (>40 mmHg), or respirator dependency
• Renal
  • Receiving chronic dialysis
• Immunosuppression
  • The patient has received therapy that suppresses resistance to infection e.g. immuno-suppression, chemotherapy, radiation, or recent hight dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g. leukemia, lymphoma, AIDS

Point values

*Note: "acute renal failure" was not defined in the original study. Use clinical judgment to determine whether has acute kidney injury. Cutoffs differ slightly from original study (by less than 0.1 mg/dL) in order to account for all possible values in this electronic calculator.

Approximated in-hospital mortality rates

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/3928249", "text": "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." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/11271085", "text": "Capuzzo M, Valpondi V, Sgarbi A, Bortolazzi S, Pavoni V, Gilli G, Candini G, Gritti G, Alvisi R. Validation of severity scoring systems SAPS II and APACHE II in a single-center population. Intensive Care Med. 2000 Dec;26(12):1779-85." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/1617599", "text": "Headley J, Theriault R, Smith TL. Independent validation of APACHE II severity of illness score for predicting mortality in patients with breast cancer admitted to the intensive care unit. Cancer. 1992 Jul 15;70(2):497-503." } ], "Validations": [] }

pearls

• APACHE II is the most widely used ICU mortality prediction score.
• It differs from the original APACHE score in some ways; the number of variables is decreased and the weight of some of the variables is adjusted.
• APACHE III and APACHE IV scores were also developed but are not commonly used because their statistical method is under copyright control.
• The score was derived in a general ICU population and may be less precise when applied to specific populations such as liver failure or HIV patients.
• Since APACHE II was studied on patients newly admitted to the ICU, it is not accurate when dealing with patients transferred from another unit or another hospital. This is known as lead time bias and is addressed in APACHE III.
• The APACHE II score must be recalibrated before it can be used in a population other than the one it was derived in.
• ICU prediction scores in general need to be periodically recalibrated to reflect changes in practice and patient demographics.

usecase

This score can be calculated on all patients newly admitted to the intensive care unit. While it is not mandatory and will not help with patient management, it is a useful tool for risk stratification and to compare the care received by patients with similar risk characteristics in different units.

reasons

Mortality prediction scores such as APACHE II are often used to assess the baseline risk groups being compared in clinical trials. They can also be used to determine prognosis and help family members make informed decisions about the aggressiveness of care.

next_advice

next_actions

• A number of variables are used to calculate the APACHE II score. The worst values recorded during the initial 24 hours in the ICU should be used. Alternatively, the variables initially recorded during the patient’s admission can be used for practical reasons.
• The APACHE II score is calculated at the beginning of the ICU admission to help determine the patient’s mortality risk for the admission. It is not calculated sequentially and is not meant to show improvement or effect of interventions. As such it should not be used to direct medical management.

next_management

The APACHE II score was designed as a mortality prediction tool but was not intended to influence the medical management of patients during their ICU stay.

diseases

[ "Coronavirus", "COVID-19", "Diabetes Mellitus", "HIV/AIDS", "Renal Failure", "Sepsis" ]

input_schema

[ { "conditionality": "", "default": null, "label_en": "<p>History of severe organ failure or immunocompromise</p>", "mdcalc_info_concept": null, "name": "organ_insufficiency", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Heart Failure Class IV, cirrhosis, chronic lung disease, or dialysis-dependent", "type": "radio" }, { "conditionality": "organ_insufficiency == 1", "default": null, "label_en": "<p>Type of surgery</p>", "mdcalc_info_concept": null, "name": "surgery", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Emergency", "value": 0 }, { "label": "Elective", "value": 1 }, { "label": "Nonoperative", "value": 2 } ], "show_points": false, "tips_en": "", "type": "radio" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Age</p>", "name": "age", "optional": false, "tips_en": "", "type": "textbox", "unit": "age" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Temperature</p>", "name": "temperature", "optional": false, "tips_en": "", "type": "textbox", "unit": "temp" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Mean arterial pressure</p>", "name": "mean_arterial_pressure", "optional": false, "tips_en": "", "type": "textbox", "unit": "map" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>pH</p>", "name": "ph", "optional": false, "tips_en": "", "type": "textbox", "unit": "ph" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Heart rate/pulse</p>", "name": "heart_rate", "optional": false, "tips_en": "", "type": "textbox", "unit": "hr" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Respiratory rate</p>", "name": "respiratory_rate", "optional": false, "tips_en": "", "type": "textbox", "unit": "rr" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Sodium</p>", "name": "sodium", "optional": false, "tips_en": "", "type": "textbox", "unit": "na" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Potassium</p>", "name": "potassium", "optional": false, "tips_en": "", "type": "textbox", "unit": "k" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Creatinine</p>", "name": "creatinine", "optional": false, "tips_en": "", "type": "textbox", "unit": "cr" }, { "conditionality": "", "default": null, "label_en": "<p>Acute renal failure</p>", "md_calc_info_concept": null, "name": "acute_renal_failure", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": false, "tips_en": "Note: \"acute renal failure\" was not defined in the original study. Use clinical judgment to determine whether patient has acute kidney injury.", "type": "toggle" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>Hematocrit</p>", "name": "hematocrit", "optional": false, "tips_en": "", "type": "textbox", "unit": "hct" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p>White blood cell count</p>", "name": "white_blood_cell_count", "optional": false, "tips_en": "", "type": "textbox", "unit": "wbc" }, { "conditionality": "", "default": null, "fhir_rules": null, "inct": null, "label_en": "<p><calculator id=\"64\">Glasgow Coma Scale</calculator></p>", "name": "glasgow_coma_scale", "optional": false, "tips_en": "", "type": "textbox", "unit": "gcs" }, { "conditionality": "", "default": null, "label_en": "<p>FiO₂</p>", "mdcalc_info_concept": null, "name": "fio2", "option_fhir_rules": null, "optional": false, "options": [ { "label": "<50% (or non-intubated)", "value": 0 }, { "label": "≥50%", "value": 1 } ], "show_points": false, "tips_en": "", "type": "radio" }, { "conditionality": "fio2 == 0", "default": null, "label_en": "<p>PaO₂, mmHg</p>", "mdcalc_info_concept": null, "name": "pao2", "option_fhir_rules": null, "optional": false, "options": [ { "label": ">70", "value": 0 }, { "label": "61-70", "value": 1 }, { "label": "55-60", "value": 3 }, { "label": "<55", "value": 4 } ], "show_points": false, "tips_en": "", "type": "radio" }, { "conditionality": "fio2 == 1", "default": null, "label_en": "<p>A-a gradient</p>", "mdcalc_info_concept": null, "name": "aa_grad", "option_fhir_rules": null, "optional": false, "options": [ { "label": "<200", "value": 0 }, { "label": "200-349", "value": 2 }, { "label": "350-499", "value": 3 }, { "label": ">499", "value": 4 } ], "show_points": false, "tips_en": "", "type": "radio" } ]

instructions

published

2022-04-21T20:29:03.406Z

purpose

[ "Prognosis" ]

search_terms

[ "apache score", "apache ii score", "apache 2 score", "apache calc", "apache ii calc", "apache 2 calc", "apache ICU score", "apache ICU calc", "apache mortality estimate", "apache mortality", "apache mortality calc", "ICU mortality calc", " icu mortality estimate", "icu apache", "intensive apache", "intensive mortality calc", "intensive mortality score" ]

seo

{ "keywords_en": "apache score, apache ii score, apache 2 score, apache calc, apache ii calc, apache 2 calc, apache ICU score, apache ICU calc, apache mortality estimate, apache mortality, apache mortality calc, ICU mortality calc, icu mortality estimate, icu apache, intensive apache, intensive mortality estimate, intensive mortality calc, intensive mortality score", "meta_description_en": "The Apache II Score estimates ICU mortality based on a number of laboratory values and patient signs taking both acute and chronic disease into account." }

specialty

[ "Critical Care", "Emergency Medicine", "Hospitalist Medicine", "Internal Medicine", "Surgery (General)" ]

departments

[ "Infectious" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 4059, "short_title_en": "MODS", "slug": "multiple-organ-dysfunction-score-mods" }, { "calcId": 4044, "short_title_en": "SAPS II", "slug": "simplified-acute-physiology-score-saps-ii" }, { "calcId": 10403, "short_title_en": "SAPS 3", "slug": "simplified-acute-physiology-score-saps-3" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "infectious" ]

cleaned_use

[ "This score can be calculated on all patients newly admitted to the intensive care unit. While it is not mandatory and will not help with patient management, it is a useful tool for risk stratification and to compare the care received by patients with similar risk characteristics in different units." ]

pub

true