APACHE score

The APACHE score is based on the APACHE method ( Acute Physiology And Chronic Health Evaluation ), a method used in intensive care units to predict the probability of survival of patients in an intensive care unit. This scoring system includes information on the patient's age, current findings and anamnestic information.

development

The APACHE method was developed by William A. Knaus at the George Washington University Hospital from around 1978 and was first used in 1981 with APACHE I. In 1985, APACHE II was introduced after it had been found that the complexity of APACHE I often prevented practical use. In 1991 the successor APACHE III appeared. In contrast to APACHE II , with APACHE III the evaluation is done with software help . APACHE III compares the entered data with the stored characteristic values of approx. 18,000 cases from 40 US hospitals. The APACHE III. The prognosis given occurs with a probability of 95%. More recently, other risk scores , such as the Simplified Acute Physiology Score (SAPS) II and the Multiple Organ Dysfunction Score (MODS), have also been used.

A study published in Germany in 2001 showed that APACHE II made more precise predictions in the examined patient group than the newer APACHE III .

APACHE II

The APACHE II consists of three data groups:

the Acute Physiology Score
the Age Points
the Chronic Health Points

The formula is: APACHE II = (Acute Physiology Score) + (Age Points) + (Chronic Health Points)

The required data is collected over 24 hours, with the worst value being used to calculate the score. As a study with more than 5800 intensive care patients showed, the development predicted by APACHE II occurs in about 80% of all cases.

Acute Physiology Score

Elevated values	+4	+3	+2	+1	0	+1	+2	+3	+4
	Deviation upwards					Deviation downwards
Temp. Rectal ° C	≥ 41 °	39 - 40.9 °		38.5-38.9	36-38.4 °	34-35.9 °	32-33.9 °	30 - 31.9 °	≤ 29.9 °
Art. Medium pressure mmHg	≥ 160	130-159	110 - 129		70-109		50-69		≤ 49
Heart rate / min	≥ 180	140-179	110-139		70-109		55-69	40 - 54	≤ 39
Respiratory rate ¹⁾ / min	≥ 50	35 - 49		25 - 34	12-24	10-11	6 - 9		≤ 5
Oxygenation ²⁾	≥ 500	350-499	200 - 349		<200 \| > 70	61-70		55-60	<55
pH	≥ 7.7	7.6 - 7.69		7.5 - 7.59	7.33-7.49		7.25-7.32	7.15-7.24	<7.15
Na +	≥ 180	160-179	155-159	150-154	130-149		120 - 129	111-119	≤ 110
K +	≥ 7	6 - 6.9		5.5-5.9	3.5-5.4	3.0-3.4	2.5-2.9		<2.5
Creatinine ³⁾ mg / dl	≥ 3.5	2.0-3.4	1.5 - 1.9		0.6 - 1.4		<0.6
Hematocrit%	≥ 60		50-59.9	46-49.9	30-45.9		20-29.9		<20
White blood cells (x1000)	≥ 40		20-39.9	15-19.9	3-14.9		1 - 2.9		<1
Glasgow Coma Scale (GCS)	Points = 15 - current GCS

1) artificial respiration or spontaneous breathing

2) If the FiO _{2 is} ≥ 0.5, the alveolo-arterial oxygen difference AaDO ₂ must be taken into account. This is calculated from AaDO2 (mmHG) = pAO ₂ - paO ₂ (alveolar oxygen partial pressure - arterial oxygen partial pressure), alternatively, the value can also be read from the BGA device. If FiO ₂ <0.5, the arterial oxygen pressure (paO ₂ mmHg) is taken into account. The first value corresponds to AaDO ₂ , the second to paO ₂

3) In the case of acute kidney failure (ANV), the points must be doubled.

Age point

A point value is determined according to the age of the patient.

Age	≤ 44	45 - 54	55-64	65-74	≥ 75
Points	0	2	3	5	6th

Chronic Health Score

Operational status	Health status	Points
Not operated on	A history of organ insufficiency or immune deficiency ¹⁾	+5
Not operated on	Immune Competent and without severe organ insufficiency in prehistory	+0

Post-operative patient after emergency surgery	There is a history of organ insufficiency or immunodeficiency	+5
Post-operative patient after emergency surgery	Immune Competent and without severe organ insufficiency in prehistory	+0

Postoperative patient after elective surgery	A history of organ insufficiency or immune deficiency ¹⁾	+2
Postoperative patient after elective surgery	Immune Competent and without severe organ insufficiency in prehistory	+0

¹⁾ The organ insufficiency or the immunosuppressed status must have been known prior to the current hospital stay and must meet the following catalog of criteria:

liver	Biopsy-confirmed cirrhosis and portal high pressure or History of upper gastrointestinal bleeding, originating from portal hypertension or Previous episodes of hepatic insufficiency / hepatic encephalopathy / hepatic coma
Cardiovascular	New York Heart Association Class IV
breathing	Chronic restrictive, obstructive, or vascular diseases that are associated with severe limitation in light tasks (e.g. inability to climb stairs or manage household chores) or chronic hypoxia, hypercapnia, acquired polycythemia , severe pulmonary hypertension (> 40mmHg) or Dependence on ventilation
kidney	chronic dialysis
immunodeficiency	The patient's immune system is weakened as a result of therapy. (For example immunosuppression, chemotherapy, radiation, long-term or high-dose steroids) Diseases associated with an immunodeficiency (e.g. leukemia, lymphoma, AIDS)

evaluation

Minimum: 0 points

Maximum: 71 points

Points scored	0-4	5 - 9	10-14	15-19	20 - 24	25-29	30 - 34	> 34
Death rate	≈ 4%	≈ 8%	≈ 15%	≈ 25%	≈ 40%	≈ 55%	≈ 75%	≈ 85%

For the exact calculation of the probability of death , the APACHE II score is inserted into the following function at the point . For a previous emergency operation, a 1 is inserted, if this condition is not met, a 0. The variable stands for a value resulting from the reason for admission to the intensive care unit. The values for 50 different reasons for admission are given in the appendix to the primary publication. ${\ displaystyle p}$ ${\ displaystyle z}$ ${\ displaystyle y}$ ${\ displaystyle x}$

{\ displaystyle p = {\ frac {1} {1 + e ^ {- 3 {,} 517} + (z \ cdot 0 {,} 146) + (y \ cdot 0 {,} 603) + x}} }

literature

William A. Knaus: APACHE 1978-2001: The development of a quality assurance system based on prognosis: Milestones and personal reflections. In: Archives of Surgery . 2002.

Web links

swell

^ WA Knaus, JE Zimmerman, DP Wagner, EA Draper, DE Lawrence: APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. In: Crit Care Med. 9 (8), Aug 1981, pp. 591-597 . PMID 7261642
^ WA Knaus, EA Draper, DP Wagner, JE Zimmerman: APACHE II: a severity of disease classification system. In: Crit Care Med. 13 (10), Oct 1985, pp. 818-829. PMID 3928249
^ R. Markgraf, G. Deutschinoff, L. Pientka, T. Scholten, C. Lorenz: Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization. In: Crit Care. 5 (1), 2001, pp. 31-36. PMID 11178223

[1] WA Knaus, JE Zimmerman, DP Wagner, EA Draper, DE Lawrence: APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. In: Crit Care Med. 9 (8), Aug 1981, pp. 591-597 . PMID 7261642

[2] WA Knaus, EA Draper, DP Wagner, JE Zimmerman: APACHE II: a severity of disease classification system. In: Crit Care Med. 13 (10), Oct 1985, pp. 818-829. PMID 3928249

[3] R. Markgraf, G. Deutschinoff, L. Pientka, T. Scholten, C. Lorenz: Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization. In: Crit Care. 5 (1), 2001, pp. 31-36. PMID 11178223