APACHE (Acute physiology and chronic health evaluation)

Case presentation

Case

20 yr old she male pt with no knowncomorbidity presented in ED with H/O RTA------2days Sever abdominal pain ---1day Vomitting --------------------1 day

examination

B.P=80/60 Pulse=110 R.R=22 Temp=38 c Abdomen was not moving along the respiration $ tense and tender & no gut sounds audible P/R =NAD

investigations

CBC=Hgb 14 .TLC 2.7 Urea =77 Cr=2.7 S.Na=126 S.K=4.34 INR=3.7 CXR=gas under diaphragm

APACHE

William Knaus (1981) Initially 34 physiological variables 1985 APACHE II 12 variables It was devised to stratify prognosis in groups of critically ill patients, and to determine the success of treatment. APACHE II allows probability of death before Standardized mortality ratio

hospital discharge to be estimated

APACHE II score
APACHE II score includes

Acute physiology score age points chronic health points

Acute physiology score

The 12 variables comprising the APS are:
1. 2. 3. 4. 5.

temperature (C); mean arterial pressure (mmHg); heart rate (beats/min); respiratory rate (breaths/min); alveolararterial oxygen gradient (AaDo2) if fractional inspired oxygen (Fio2) is 0.5 or greater, or use Pao2 if Fio2 is less than 0.5; arterial pH; serum sodium (mmol/l); serum potassium (mmol/l); serum creatinine (mg/l00ml); haematocrit (%); leucocyte count (cells/mm3); Glasgow coma score.

6. 7. 8. 9. 10. 11. 12.

Chronic Health Points

If the patient has a history of severe organ system deficiency or is immuno compromised LIVER: Biopsy proven cirrhosis and documented portal hypertension episodes of past upper GI bleeding attributed to portal hypertension: prior episodes of hepatic failure/encephalopathy/coma. RENAL: Recurring chronic dialysis ESPIRATORY: Chronic restrictive, obstructive, or vascular disease resulting in severe exercise restriction. Unable to climb stairs or perform household duties: or documented chronic hypoxia, hypercapnia, secondary polycythemia, severe pulmonary hypertension ( > 40mmHg), or respirator dependancy.

Chronic Health Points

Non-operative patients..5 points Emergency postoperative .5 points Elective postoperative ...3 points

Patients

patients

AGE POINTS

AGE (yrs) < 44 45 - 54 55 - 64 65 - 74 > 75

POINTS 0 2 3 5 6

summary

The maximum possible APACHE II score is 71. In Our patent it was 18. Increasing scores correlate with higher hospital mortality, at each 5-point increment. APACHE II is potentially sensitive to treatment effects preceding admission to the intensive care unit.

e.g. patients who are resuscitated and treated (for hours or days) in one hospital before being transferred to the intensive care unit in another will present to the new hospital with an unrepresentatively low APACHE II in relation to their risk of death.

Take Home Message

A trend analysis may therefore be more appropriate, utilizing sequential APACHE scores at fixed intervals (e.g. daily), and noting the rate of change relative to the last score.