The Acute Physiology and Chronic Health Evaluation (APACHE) score is a illness severity score commonly used in critical care medicine to predict mortality upon admission to an intensive care unit.
It involves two sections - one assessing the severity of the acute illness and another to assess the pre-illness chronic medical status of the patient. The worst values achieved by the patient in the first 24 hours of admission to the intensive care unit should be used 2.
The following criteria are used in the calculation of the APACHE II score 2:
- past history of organ failure or immunocompromised state (e.g. NYHA Class IV heart failure, cirrhosis, CKD requiring dialysis)
- acute kidney injury
- mean arterial pressure
- blood pH
- heart rate
- respiratory rate
- white blood cell count
- Glasgow Coma Scale
- blood oxygenation:
- A-a gradient (if FiO2 is greater than or equal to 0.5)
- PaO2 (if FiO2 is less than 0.5)
Although designed for the calculation of mortality in an intensive care unit the APACHE score has high sensitivity for the prediction of complications of acute pancreatitis such as pancreatic necrosis and organ failure 3.
History and etymology
The APACHE score was first developed in 1981 by the American intensivist William Knaus and his colleagues 1. It was revised in 1985 to become the APACHE II score 2. It is currently in its fourth iteration, however the APACHE II score is still the most commonly used.
- 1. Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. (1981) Critical care medicine. 9 (8): 591-7. Pubmed
- 2. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. (1985) Critical care medicine. 13 (10): 818-29. Pubmed
- 3. Kumar AH, Mahavir SG. A comparison of APACHE II, BISAP, Ranson’s score and modified CTSI in predicting the severity of acute pancreatitis based on the 2012 revised Atlanta Classification. (2017). Gastroenterology Report. DOI