APACHE II

(Acute Physiology And Chronic Health Evaluation)

Temperature (°C)

Mean Arterial Pressure (mmHg)

Heart Rate

Respiratory Rate

If FIO2 >= 0,5 : (A-a) O2

If FIO2 < 0,5 : PaO2

If no A.B.Gs :
Serum HCO3^-(mmol/L)

Arterial pH

Serum Sodium (mmol/L)

Serum Potassium (mmol/L)

Serum Creatinine
With Acute Renal Failure

Serum Creatinine
Without Acute Renal Failure

Ht (%)

W.B.C (x10³/ mm³ )

Glasgow Coma Score

Age

Apache II

Chronic Organ Insufficiency
immuno-compromised

Predicted death rate

Logit = -3,517+( Apache II) * 0,146
Predicted Death Rate =e^Logit/(1+e^Logit)

Predicted death rate (Adjusted)

Logit = -3,517+( Apache II) * 0,146 + Diagnostic category weight
Predicted Death Rate =e^Logit/(1+e^Logit)
Diagnostic category weight (y)= (a point for decimals)

Nonoperative
y
Postoperative patients
y
y (if emergency)

Respiratory failure or insufficiency from:

Multiple trauma

-1.684
-1.081

Asthma / allergy

-2.108

Admission due to chronic cardiovascular disease

-1.376
-0.773

COPD

-0.367

Peripheral vascular surgery

-1.315
-0.712

Pulmonary edema (noncardiogenic)

-0.251

Heart valve surgery

-1.261
-0.658

Postrespiratory arrest

-0.168

Craniotomy for neoplasm

-1.245
-0.642

Aspiration / poisoning / Toxic

-0.142

Renal surgery for neoplasm

-1.204
-0.601

Pulmonary embolus

-0.128

Renal Transplant

-1.042
-0.439

Infection

0

Head trauma

-0.955
-0.352

Neoplasm

0.891

Thoracic surgery for neoplasm

-0.802
-0.199

Cardiovascular failure or insufficiency from :

Craniotomy for ICH/ SDH/ SAH

-0.788
-0.185

Hypertension

-1.798

Laminectomy and other spinal cord surgery

-0.699
-0.096

Rythm disturbance

-1.368

Hemorrhagic shock

-0.682
-0.079

Congestive heart failure.

-0.424

GI Bleeding

-0.617
-0.014

Hemorrhagic shock / hypovolemia

0.493

GI surgery for neoplasm

-0.248
0.355

Coronary artery disease

-0.191

Respiratory insufficiency

-0.140
0.463

Sepsis

0.113

GI perforation / obstruction

0.060
0.663

Post cardiac arrest

0.393

If not in one of the above, wich major vital organ system led to ICU admission post surgery

Cardiogenic shock

-0.259

Neurologic

-1.150
-0.574

Dissecting thoracic / abdomina aneurysm

0.731

Cardiovascular

-0.797
-0.194

Trauma

Respiratory

-0.610
-0.007

Multiple trauma

- 1.228

Gastro-intestinal

-0.613
-0.01

Head injury

-0.517

Metabolic / renal

-0.196
0.407

Neurologic

Seizure disorder

-0.584

ICH/ SDH/ SAH

0.723

Other

Drug overdose

-3.353

Diabetic ketoacidosis

-1.507

GI Bleeding

0.334

If not in one of the groups above, wich major organ system was the principal reason for admission:

Metabolic / renal

-0.885

Respiratory

-0.890

Neurologic

-0.759

Cardiovascular

0.470

Gastrointestinal

0.501

Ref : Knaus WA et al. APACHE II : A severity of disease classification system. Crit Care Med. 1985;13:818-29.

Web page by : Jean-Yves Marandon , MD and John C. Pezzullo, PhD, Associate Professor, Pharmacology and Biostatistics
Georgetown University Medical Center (USA)

(A-a)O2 Gradient ( mmHg )		(A-a)O2 Gradient ( KPa )
PaCO2	(A-a)O2 Gradient	(A-a)O2 Gradient	PaCO2
PaO2			PaO2
FIO2 (a point for decimals) (ex: 0.6)			FIO2 (a point for decimals) (ex: 0.6)
Formula (simplified): (A-a)O2 Gradient = (( PAtm - PH2O) * FIO2 - ( PaCO2 / Resp.Quot )) - PaO2 With R.Q =1 , PAtm =760, PH2O = 47 (A-a)O2 Gradient =(760-47)*FIO2 - PaCO2 - Pa02		Formula (simplified): (A-a)O2 Gradient = (( PAtm - PH2O) * FIO2 - ( PaCO2 / Resp.Quot )) - PaO2 with RQ =1 , PAtm =100, PH2O = 6.2 (A-a)O2 Gradient =(100-6.2)*FIO2 - PaCO2 - Pa02

Chronic Organ Insufficiency

Liver insufficiency

Cardiovascular
Respiratory
Renal

Immuno-depression

Biopsy proven cirrhosis
Documented portal hypertension,
Episodes of past upper GI bleeding attributed to portal hypertension
Prior episodes of hepatic failure / encephalopathy / coma.
NYHA Class IV
Chronic restrictive, obstructive or vascular disease resulting in severe exercice restriction, i.e. unable to climb stairs or perform household duties.
Documented chronic hypoxia, hypercapnia, secondary polycythemia , severe pulmonary hypertension (> 40 mmHg), or respirator dependency.

Receiving chronic dialysis

The patient has received therapy that suppresses resistance to infection e.g. immuno-suppression, chemotherapy, radiation, long term or recent hight dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g. leukemia, lymphoma, AIDS.

Eyes Open	Verbal	Motor
Spontaneous To speech To pain Absent	Converses / Oriented Converses / Disoriented Inappropriate Incomprehensible Absent	Obeys Localizes pain Withdraws (flexion) Decorticate (flexion) rigidity Decerebrate (extension) rigidity Absent

Nonoperative	y	Postoperative patients	y	y (if emergency)
Respiratory failure or insufficiency from:		Multiple trauma	-1.684	-1.081
Asthma / allergy	-2.108	Admission due to chronic cardiovascular disease	-1.376	-0.773
COPD	-0.367	Peripheral vascular surgery	-1.315	-0.712
Pulmonary edema (noncardiogenic)	-0.251	Heart valve surgery	-1.261	-0.658
Postrespiratory arrest	-0.168	Craniotomy for neoplasm	-1.245	-0.642
Aspiration / poisoning / Toxic	-0.142	Renal surgery for neoplasm	-1.204	-0.601
Pulmonary embolus	-0.128	Renal Transplant	-1.042	-0.439
Infection	0	Head trauma	-0.955	-0.352
Neoplasm	0.891	Thoracic surgery for neoplasm	-0.802	-0.199
Cardiovascular failure or insufficiency from :		Craniotomy for ICH/ SDH/ SAH	-0.788	-0.185
Hypertension	-1.798	Laminectomy and other spinal cord surgery	-0.699	-0.096
Rythm disturbance	-1.368	Hemorrhagic shock	-0.682	-0.079
Congestive heart failure.	-0.424	GI Bleeding	-0.617	-0.014
Hemorrhagic shock / hypovolemia	0.493	GI surgery for neoplasm	-0.248	0.355
Coronary artery disease	-0.191	Respiratory insufficiency	-0.140	0.463
Sepsis	0.113	GI perforation / obstruction	0.060	0.663
Post cardiac arrest	0.393	If not in one of the above, wich major vital organ system led to ICU admission post surgery
Cardiogenic shock	-0.259	Neurologic	-1.150	-0.574
Dissecting thoracic / abdomina aneurysm	0.731	Cardiovascular	-0.797	-0.194
Trauma		Respiratory	-0.610	-0.007
Multiple trauma	- 1.228	Gastro-intestinal	-0.613	-0.01
Head injury	-0.517	Metabolic / renal	-0.196	0.407
Neurologic
Seizure disorder	-0.584
ICH/ SDH/ SAH	0.723
Other
Drug overdose	-3.353
Diabetic ketoacidosis	-1.507
GI Bleeding	0.334
If not in one of the groups above, wich major organ system was the principal reason for admission:
Metabolic / renal	-0.885
Respiratory	-0.890
Neurologic	-0.759
Cardiovascular	0.470
Gastrointestinal	0.501

Liver insufficiency	Cardiovascular	Respiratory	Renal	Immuno-depression
Biopsy proven cirrhosis Documented portal hypertension, Episodes of past upper GI bleeding attributed to portal hypertension Prior episodes of hepatic failure / encephalopathy / coma.	NYHA Class IV	Chronic restrictive, obstructive or vascular disease resulting in severe exercice restriction, i.e. unable to climb stairs or perform household duties. Documented chronic hypoxia, hypercapnia, secondary polycythemia , severe pulmonary hypertension (> 40 mmHg), or respirator dependency.	Receiving chronic dialysis	The patient has received therapy that suppresses resistance to infection e.g. immuno-suppression, chemotherapy, radiation, long term or recent hight dose steroids, or has a disease that is sufficiently advanced to suppress resistance to infection, e.g. leukemia, lymphoma, AIDS.