APACHE II uses a point score based upon initial values of 12 routine physiologic measurements, age, and previous health status to provide a general measure of severity of disease.
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:
- 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
