ICU mortality – APACHE II score

APACHE II Score. Used to determine the risk of death in ICU patients. Estimates ICU mortality

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 (furtherest from baseline/normal) should be used.

Chronic organ insufficiency or immunocompromise history:

  • Yes (+ s/p emergency surgery): +6 points
  • Yes (+ s/p elective surgery): +2 points
  • Yes (but not post-op): +5 points
  • No: 0 points

Acute Renal Failure:

  • Yes: +1 point
  • No: 0 points

Age (years)

Temperature

Mean Arterial Pressure (mm Hg)

pH

Heart Rate/Pulse (beats per minute)

Respiratory Rate (breaths per minute)

Sodium (mEq/L)

Potassium (mEq/L)

Creatinine (mg/dL)

Hematocrit (%)

White Blood Cell Count (cells/µL)

Glasgow Coma Scale (points)

A-a Gradient (if FiO2 ≥ 0.5) (mm Hg)

PaO2 (if FiO2 < 0.5)

Calculator: http://www.mdcalc.com/apache-ii-score-for-icu-mortality/

The following defines “chronic organ insufficiency” and immunocompromised:

  • Liver insufficiency
    • Biopsy proven cirrhosis
    • Documented portal hypertension
    • Episodes of past upper GI bleeding attributed to portal hypertension
    • Prior episodes of hepatic failure / encephalopathy / coma.
  • Cardiovascular
    • New Heart Association Class IV Heart Failure
  • Respiratory
    • Chronic restrictive, obstructive or vascular disease resulting in severe exercice restriction, i.e. unable to climb stairs or perform household duties.
    • Documented chronic hypoxia, hypercapnia, secondary polycythemia , 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, long term or recent hight dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g. leukemia, lymphoma, AIDS.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system.

http://www.mdcalc.com/apache-ii-score-for-icu-mortality/

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