Unifying Concepts

The APACHE II Severity of Disease Classification System

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



  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

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