The physician lists an APACHE score in his note. What factors are used to determine this score? What does this mean? Ranson's Criteria and the Atlanta Criteria are also used to determine the severity of pancreatitis

Question

Define each of these sets of criteria.

Answer 1

The APACHE (Acute Physiology and Chronic Health Evaluation) is a rating scale used to predict the severity of the disease and is based on several physiological factors. The APACHE score is used in ICU/trauma units and is an indicator of mortality risk. Scores range from 0-71 with higher scores signifying an increased severity and greater risk of mortality.
The APACHE score consists of 12 components, including blood pressure, temperature, heart rate, mean arterial pressure, oxygenation of arterial blood, arterial pH, serum sodium, potassium, creatinine, and hematocrit, as well as WBC count and GCS.
Mr. Mahon has an APACHE score of 4, which indicates a 4% mortality risk based on his current situation. This means that Mr. Mahon's acute pancreatitis is mild.

Ranson's Criteria was developed for alcoholic acute pancreatitis and consists of 5 measurements at admission and 6 measurements for the 48 hour mark following. Meeting three or more criteria is associated with a significantly higher risk of mortality. The admission values are as follows: age > 55 yr, WBC > 66,000/mL, LDH > 350 IU/L, AST > 250 IU/L, and glucose > 200 mg/dL. The 48-hour criteria include: Hct decrease > 10%, BUN increase > 5 mg/dL, Ca < 8 mg/dL, PaO2 < 60 mmHg, and fluid sequestration > 6 L.

The Atlanta Criteria consists of three classifications of acute pancreatitis: mild, moderately severe, and severe. The mild classification is considered to be the absence of organ failure and local complications. The moderately severe category include local complications (such as necrosis or fluid accumulation) and/or transient organ failure (< 48 hrs). Finally, the severe classification is for persistent organ failure, lasting more than 48 hrs.