APACHE score

Last revised by Henry Knipe on 3 Mar 2024

The Acute Physiology and Chronic Health Evaluation (APACHE) score is an illness severity score commonly used in critical care medicine to predict mortality upon admission to an intensive care unit. 

Although designed for the calculation of mortality in an intensive care unit the APACHE score has a high sensitivity for the prediction of complications of acute pancreatitis such as pancreatic necrosis and organ failure 3. In 2006, the fourth iteration - APACHE IV - was published 4, however, the APACHE II score is still the most commonly used ref.

It involves two sections - one assessing the severity of the acute illness and another assessing the pre-illness chronic medical status of the patient. The worst values the patient achieves 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

  • age

  • temperature

  • mean arterial pressure

  • blood pH

  • heart rate

  • respiratory rate

  • sodium

  • potassium

  • creatinine

  • hematocrit

  • 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)

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.

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