Combination ICU Mortality Calculator (APACHE II, SAPS II, SOFA) (2024)

APACHE II, SAPS II, and SOFA scores to predict hospital mortality

ClinCalc.com » Critical Care » Acute Physiology and Chronic Health Evaluation (APACHE II) Calculator

Use the

worst

value for each physiological variable within the past 24 hours.

VITALS
HR	BP	RR	Temp	GCS
bpm	/ mmHg	bpm	C or F

ARTERIAL BLOOD GAS
pH	pCO2	pO2	FiO2
			%
Mechanical ventilation or CPAP		Yes No
Atmospheric pressure

CHEM-7
Na	K	CO2	BUN	SCr
mEq/L	mEq/L	mEq/L
Acute renal failure			Yes No

CBC
WBC	Hct	Plt
x 109/L	%	x103/mm3

MISC METRICS
Urine output	mL
Bilirubin
Vasopressors	No Yes
Dopamine	mcg/kg/min
Dobutamine	mcg/kg/min
Epinephrine	mcg/min mcg/kg/min
Norepinephrine	mcg/min mcg/kg/min
Weight	kg lbs
CHRONIC HEALTH
Age	years
Chronic diseases	Metastatic cancer Hematologic malignancy AIDS
Type of admission
Does this patient have severe organ system insufficiency or is immunocompromised? See definitions	No Yes

US units

See Also

Aminoglycoside Calculator - ClinCalc.comCreatinine Clearance Calculator - ClinCalc.comEinstein’s Derivation of E=mc2: The Equivalence of Mass and EnergyInterpreting Evaluating Respiratory Symptoms™ in COPD Diary Scores in Clinical Trials: Terminology, Methods, and Recommendations

About This Calculator

This calculator is designed for researchers who are calculating a number of different ICU mortality scores on a single patient. By combining data entry into one form, a researcher will not be required to enter the same variable (such as heart rate or serum sodium) multiple times on multiple online calculators.

For more information about an individual mortality models (such as inclusion/exclusion, variables included, correlation to mortality, etc.), please visit each respective calculators:

• Acute Physiology and Chronic Health Evaluation (APACHE II) Calculator
• Simplified Acute Physiology Score (SAPS II) Calculator
• Sequential Organ Failure Assessment (SOFA) Calculator

Definitions of 'severe organ system insufficiency' and 'immunocompromised'

• Liver: Biopsy-proven cirrhosis with portal hypertension; episodes of past upper GI bleeding attributed to portal hypertension; or prior episodes of of hepatic failure, encephalopathy, or coma
• Cardiovascular: New York Heart Association (NYHA) class IV heart failure
• Respiratory: Chronic restrictive, obstructive, or vascular disease resulting in severe exercise restriction (ie, unable to climb stairs or perform household duties); documented chronic hypoxia, hypercapnia, secondary polycythemia, severe pulmonary hypertension (>40 mmHg); or respirator dependency
• Renal: Receiving chronic dialysis
• Immunocompromised: The patient has received therapy that suppresses resistance to infection (eg, immunosuppression, chemotherapy, radiation, long-term or high-dose steroids, or advanced leukemia, lymphoma, or AIDS)

Disadvantage of APACHE II

APACHE II scores are often reported in the literature as a point value, rather than a percent mortality. Given that APACHE II scores are reported in order to describe severity of illness in a population, it may become difficult to accurately compare two heterogeneous groups on the basis of an APACHE II score because predicted mortality is based on ICU admission indication.

As an example, an APACHE II score of 25 points is associated with a predicted mortality rate of 73.6% if admitted for neoplasm, but only 38.9% if admitted for a seizure disorder. While often times clinical trials use APACHE II scores to compare two groups within a trial who often have the same ICU admission indication, this discrepancy limits the applicability of interpreting an APACHE II score in a patient population with a variety of disease states.

Comparison of ICU Mortality Models

There have been a number of studies examining the difference in accuracy between various ICU mortality prediction models. A summary of three prospective, large, multicenter studies is shown below, in addition to the original publications for both SAPS II and APACHE II.

AUC ROC (area under curve, receiver operating characteristic) is a measure of the specificity and sensitivity of a prediction method. AUC ROC is described between 0.5 and 1.0, with an AUC of 1.0 being perfectly sensitive and specific. Generally speaking, an AUC above 0.8 is desirable.

Overall Poor Performance

In two of the trials 4^,5 both SAPS II and APACHE II demonstrated a significant value for the Hosmer-Lemeshow goodness-of-fit test (p < 0.001), which is indicative that both models performed poorly despite showing a moderate AUC ROC (eg, there was a significant discrepancy between expected and observed mortality).

As highlighted by the poor results of the goodness-of-fit tests, there are a number of unique patient factors that cannot be accounted for in an ICU mortality model. Despite this fact, both SAPS II and APACHE II are still widely used to describe illness severity in clinical trials.

References and Additional Reading

©2024 - ClinCalc LLC. All rights reserved.