|
Overview :
The APACHE (Acute Physiology And Chronic Health Evaluation)
is a system for classifying patients in the intensive care unit. Patients are
evaluated by physiologic scores and evaluation of chronic health status.
Physiologic scores correlate with severity of illness. Results of the evaluation
can be used to estimate the mortality rate for patients in the ICU and during
the hospitalization.
Physiologic classes of variables (total 8 classes with 34
variables):
(1) cardiovascular: 7 variables
(2) respiratory: 3 variables
(3) renal: 3 variables
(4) gastrointestinal: 6 variables
(5) hematologic: 4 variables
(6) septic: 4 variables
(7) metabolic: 6 variables
(8) neurologic: 1 variable
Scoring:
• The
physiologic data is evaluated during the first 32 hours after admission to the
ICU.
• Each
variable is assigned a value of 0 to 4, based on significance of deviation from
normal, with more severe deviations given higher values.
Cardiovascular
|
Parameter |
Finding |
Points |
|
heart rate ventricular response |
>= 180 |
+4 |
|
|
141 – 179 |
+3 |
|
|
111- 140 |
+2 |
|
|
70 – 110 |
0 |
|
|
56 – 69 |
+2 |
|
|
41 – 55 |
+3 |
|
|
<= 40 |
+4 |
|
mean arterial pressure in mm Hg |
>= 160 |
+4 |
|
|
131 – 159 |
+3 |
|
|
111 – 130 |
+2 |
|
|
70 – 110 |
0 |
|
|
51 – 69 |
+2 |
|
|
<= 50 |
+4 |
|
right atrial pressure or central venous pressure in mm
HG |
>= 26 |
+2 |
|
|
16 - 25 |
+1 |
|
|
1 - 15 |
0 |
|
|
< 1 |
+1 |
|
evidence of acute MI |
Yes |
+4 |
|
|
No |
0 |
|
ECG arrhythmias |
atrial arrhythmias and hemodynamic instability |
+3 |
|
|
atrial arrhythmias alone |
+2 |
|
|
> 6 PVCs per minute |
+3 |
|
|
ventricular tachycardia or fibrillation |
+4 |
|
serum lactate in mg/dL |
> 72 |
+4 |
|
|
30.7 – 72 |
+3 |
|
|
0 – 36.6 |
0 |
|
arterial pH |
>= 7.70 |
+4 |
|
|
7.60 – 7.69 |
+3 |
|
|
7.51 – 7.59 |
+1 |
|
|
7.33 – 7.50 |
0 |
|
|
7.25 – 7.32 |
+2 |
|
|
7.15 – 7.24 |
+3 |
|
|
< 7.15 |
+4 |
where:
• mean
arterial blood pressure = (((systolic blood pressure) + (2 * (diastolic blood
pressure))) / 3)
• Evidence of an acute MI may include ECG, serum marker
changes, or other.
• serum
lactate expressed in mEq/L, which is no longer used routinely. This was assumed
to be equivalent to mmol/L, which is converted to mg/dL by multiplying by 9
Respiratory
|
Parameter |
Finding |
Points |
|
respiratory rate nonventilated |
>= 50 |
+4 |
|
|
35 – 49 |
+3 |
|
|
26 – 34 |
+1 |
|
|
12 – 25 |
0 |
|
|
10 – 11 |
+1 |
|
|
7 – 9 |
+2 |
|
|
<= 6 |
+4 |
|
P(A-a)O2 with FIO2 = 1.0 |
>= 500 |
+4 |
|
|
351 – 499 |
+3 |
|
|
200 – 350 |
+1 |
|
|
< 200 |
0 |
|
PaCO2 |
>= 70 |
+4 |
|
|
61 - 69 |
+3 |
|
|
50 - 60 |
+2 |
|
|
30 - 49 |
0 |
|
|
25 - 29 |
+2 |
|
|
20 - 24 |
+3 |
|
|
< 20 |
+4 |
where:
• The
P(A-a)O2 for FIO2 is given as ((FIO2 as fraction from 0.21 to 1.00) * 713) -
PaCO2 - PaO2); however, the decision points for lower FIO2s are not given. These
are unlikely to be comparable to those of an FIO2 of 1.00.
Renal
|
Parameter |
Finding |
Points |
|
urine output in L per day |
>= 5 |
+2 |
|
|
> 3.5 to < 5.0 |
+1 |
|
|
0.7 to 3.5 |
0 |
|
|
0.48 to < 0.70 |
+2 |
|
|
0.12 – 0.47 |
+3 |
|
|
< 0.12 |
+4 |
|
serum BUN in mg/dL |
> 150 |
+4 |
|
|
101 – 150 |
+3 |
|
|
81 – 100 |
+2 |
|
|
21- 80 |
+1 |
|
|
10 – 20 |
0 |
|
|
< 10 |
+2 |
|
serum creatinine in mg/dL |
> 7.0 |
+4 |
|
|
3.6 – 7.0 |
+3 |
|
|
2.1 – 3.5 |
+2 |
|
|
1.6 – 2.0 |
+1 |
|
|
0.6 – 1.5 |
0 |
|
|
< 0.6 |
+1 |
Gastrointestinal
|
Parameter |
Finding |
Points |
|
serum amylase in IU |
> 2,000 |
+4 |
|
|
501 – 1,999 |
+3 |
|
|
<= 500 |
0 |
|
serum albumin in g/dL |
> 8 |
+4 |
|
|
3.5 – 8.0 |
0 |
|
|
2.5 – 3.4 |
+1 |
|
|
< 2.5 |
+2 |
|
total bilirubin in mg/dL |
>= 15 |
+3 |
|
|
5.1 – 14.9 |
+1 |
|
|
0 - 5 |
0 |
|
alkaline phosphatase in IU |
> 160 |
+1 |
|
|
0 - 160 |
0 |
|
SGOT |
>= 1,500 |
+2 |
|
|
101 – 1,499 |
|