Chest ACCP Education Calendar
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Knaus, W. A.
Right arrow Articles by Damiano, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Knaus, W. A.
Right arrow Articles by Damiano, A.

Chest, Vol 100, 1619-1636, Copyright © 1991 by American College of Chest Physicians

ARTICLES

The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults

WA Knaus, DP Wagner, EA Draper, JE Zimmerman, M Bergner, PG Bastos, CA Sirio, DJ Murphy, T Lotring and A Damiano
Department of Anesthesiology, George Washington University Medical Center, Washington, DC.

The objective of this study was to refine the APACHE (Acute Physiology, Age, Chronic Health Evaluation) methodology in order to more accurately predict hospital mortality risk for critically ill hospitalized adults. We prospectively collected data on 17,440 unselected adult medical/surgical intensive care unit (ICU) admissions at 40 US hospitals (14 volunteer tertiary-care institutions and 26 hospitals randomly chosen to represent intensive care services nationwide). We analyzed the relationship between the patient's likelihood of surviving to hospital discharge and the following predictive variables: major medical and surgical disease categories, acute physiologic abnormalities, age, preexisting functional limitations, major comorbidities, and treatment location immediately prior to ICU admission. The APACHE III prognostic system consists of two options: (1) an APACHE III score, which can provide initial risk stratification for severely ill hospitalized patients within independently defined patient groups; and (2) an APACHE III predictive equation, which uses APACHE III score and reference data on major disease categories and treatment location immediately prior to ICU admission to provide risk estimates for hospital mortality for individual ICU patients. A five- point increase in APACHE III score (range, 0 to 299) is independently associated with a statistically significant increase in the relative risk of hospital death (odds ratio, 1.10 to 1.78) within each of 78 major medical and surgical disease categories. The overall predictive accuracy of the first-day APACHE III equation was such that, within 24 h of ICU admission, 95 percent of ICU admissions could be given a risk estimate for hospital death that was within 3 percent of that actually observed (r2 = 0.41; receiver operating characteristic = 0.90). Recording changes in the APACHE III score on each subsequent day of ICU therapy provided daily updates in these risk estimates. When applied across the individual ICUs, the first-day APACHE III equation accounted for the majority of variation in observed death rates (r2 = 0.90, p less than 0.0001).


This article has been cited by other articles:


Home page
 ChestHome page
M. W. Kuzniewicz, E. E. Vasilevskis, R. Lane, M. L. Dean, N. G. Trivedi, D. J. Rennie, T. Clay, P. L. Kotler, and R. A. Dudley
Variation in ICU Risk-Adjusted Mortality: Impact of Methods of Assessment and Potential Confounders
Chest, June 1, 2008; 133(6): 1319 - 1327.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
E. M. W. van de Garde, H. Endeman, V. H. M. Deneer, D. H. Biesma, F. A. Sayed-Tabatabaei, H. J. T. Ruven, H. G. M. Leufkens, and J. M. M. van den Bosch
Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism and Risk and Outcome of Pneumonia
Chest, January 1, 2008; 133(1): 220 - 225.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
J. A. Kellum, L. Kong, M. P. Fink, L. A. Weissfeld, D. M. Yealy, M. R. Pinsky, J. Fine, A. Krichevsky, R. L. Delude, D. C. Angus, et al.
Understanding the Inflammatory Cytokine Response in Pneumonia and Sepsis: Results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) Study
Arch Intern Med, August 13, 2007; 167(15): 1655 - 1663.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
T. W. Rice, A. P. Wheeler, G. R. Bernard, D. L. Hayden, D. A. Schoenfeld, L. B. Ware, and for the National Institutes of Health, National He
Comparison of the SpO2/FIO2 Ratio and the PaO2/FIO2 Ratio in Patients With Acute Lung Injury or ARDS
Chest, August 1, 2007; 132(2): 410 - 417.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
H. Khan, J. Belsher, M. Yilmaz, B. Afessa, J. L. Winters, S. B. Moore, R. D. Hubmayr, and O. Gajic
Fresh-Frozen Plasma and Platelet Transfusions Are Associated With Development of Acute Lung Injury in Critically Ill Medical Patients
Chest, May 1, 2007; 131(5): 1308 - 1314.
[Abstract] [Full Text] [PDF]

Home page
 Arch SurgHome page
A. E. Baue
Mediators or Markers of Injury, Inflammation, and Infection (Harbingers of Doom or Predictors of Disaster) and Biologic Puzzles or Ambiguities
Arch Surg, January 1, 2007; 142(1): 89 - 93.
[Full Text] [PDF]

Home page
 Arch Intern MedHome page
J. A. Tice, A. Kanaya, T. Hue, S. Rubin, D. S. M. Buist, A. LaCroix, J. V. Lacey Jr, J. A. Cauley, S. Litwack, L. A. Brinton, et al.
Risk Factors for Mortality in Middle-aged Women
Arch Intern Med, December 11, 2006; 166(22): 2469 - 2477.
[Abstract] [Full Text] [PDF]

Home page
 Am J Crit CareHome page
L. A. Hoffman, F. J. Tasota, T. G. Zullo, C. Scharfenberg, and M. P. Donahoe
Outcomes of Care Managed by an Acute Care Nurse Practitioner/Attending Physician Team in a Subacute Medical Intensive Care Unit
Am. J. Crit. Care., March 1, 2005; 14(2): 121 - 130.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
A. M. Sutherland, K. R. Walley, S. Manocha, and J. A. Russell
The Association of Interleukin 6 Haplotype Clades With Mortality in Critically Ill Adults
Arch Intern Med, January 10, 2005; 165(1): 75 - 82.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
S. A. Ensminger, I. J. Morales, S. G. Peters, M. T. Keegan, J. D. Finkielman, J. F. Lymp, and B. Afessa
The Hospital Mortality of Patients Admitted to the ICU on Weekends
Chest, October 1, 2004; 126(4): 1292 - 1298.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
L. B. Ware, M. D. Eisner, B. T. Thompson, P. E. Parsons, and M. A. Matthay
Significance of Von Willebrand Factor in Septic and Nonseptic Patients with Acute Lung Injury
Am. J. Respir. Crit. Care Med., October 1, 2004; 170(7): 766 - 772.
[Abstract] [Full Text] [PDF]

Home page
 QJMHome page
G. Briassoulis, O. Filippou, L. Natsi, M. Mavrikiou, and T. Hatzis
Acute and chronic paediatric intensive care patients: current trends and perspectives on resource utilization
QJM, August 1, 2004; 97(8): 507 - 518.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
C. S. Parshuram and B. P. Kavanagh
Positive Clinical Trials: Understand the Control Group before Implementing the Result
Am. J. Respir. Crit. Care Med., August 1, 2004; 170(3): 223 - 226.
[Full Text] [PDF]

Home page
 Arch Intern MedHome page
D. P. Sulmasy, J. R. Sood, and W. A. Ury
The Quality of Care Plans for Patients With Do-Not-Resuscitate Orders
Arch Intern Med, July 26, 2004; 164(14): 1573 - 1578.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
The National Heart, Lung, and Blood Institute ARDS
Higher versus Lower Positive End-Expiratory Pressures in Patients with the Acute Respiratory Distress Syndrome
N. Engl. J. Med., July 22, 2004; 351(4): 327 - 336.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
T. L. Higgins
Timing Is Everything
Chest, July 1, 2004; 126(1): 4 - 6.
[Full Text] [PDF]

Home page
 Anesth. Analg.Home page
N. Petrucci and W. Iacovelli
Ventilation with Smaller Tidal Volumes: A Quantitative Systematic Review of Randomized Controlled Trials
Anesth. Analg., July 1, 2004; 99(1): 193 - 200.
[Abstract] [Full Text] [PDF]

Home page
 J. Med. EthicsHome page
J P Marcin, R K Pretzlaff, M M Pollack, K M Patel, and U E Ruttimann
Certainty and mortality prediction in critically ill children
J. Med. Ethics, June 1, 2004; 30(3): 304 - 307.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
A. H. Hamrahian, T. S. Oseni, and B. M. Arafah
Measurements of Serum Free Cortisol in Critically Ill Patients
N. Engl. J. Med., April 15, 2004; 350(16): 1629 - 1638.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
P. L. Graham and D. A. Cook
Prediction of Risk of Death Using 30-Day Outcome: A Practical End Point for Quality Auditing in Intensive Care
Chest, April 1, 2004; 125(4): 1458 - 1466.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
D. Hadjiliadis, M. P. Steele, J. A. Govert, R. D. Davis, and S. M. Palmer
Outcome of Lung Transplant Patients Admitted to the Medical ICU
Chest, March 1, 2004; 125(3): 1040 - 1045.
[Abstract] [Full Text] [PDF]

Home page
 J Antimicrob ChemotherHome page
M. Tumbarello, R. Citton, T. Spanu, M. Sanguinetti, L. Romano, G. Fadda, and R. Cauda
ESBL-producing multidrug-resistant Providencia stuartii infections in a university hospital
J. Antimicrob. Chemother., February 1, 2004; 53(2): 277 - 282.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
D. L. Paterson, W.-C. Ko, A. V. Gottberg, S. Mohapatra, J. M. Casellas, H. Goossens, L. Mulazimoglu, G. Trenholme, K. P. Klugman, R. A. Bonomo, et al.
International Prospective Study of Klebsiella pneumoniae Bacteremia: Implications of Extended-Spectrum {beta}-Lactamase Production in Nosocomial Infections
Ann Intern Med, January 6, 2004; 140(1): 26 - 32.
[Abstract] [Full Text] [PDF]

Home page
 Am J Crit CareHome page
A. L. Hendrich, J. Fay, and A. K. Sorrells
Effects of Acuity-Adaptable Rooms on Flow of Patients and Delivery of Care
Am. J. Crit. Care., January 1, 2004; 13(1): 35 - 45.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. Engoren, C. Arslanian-Engoren, and N. Fenn-Buderer
Hospital and Long-term Outcome After Tracheostomy for Respiratory Failure
Chest, January 1, 2004; 125(1): 220 - 227.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
M. A. Pisani, C. Redlich, L. McNicoll, E. W. Ely, and S. K. Inouye
Underrecognition of Preexisting Cognitive Impairment by Physicians in Older ICU Patients
Chest, December 1, 2003; 124(6): 2267 - 2274.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
S. H. Silber, C. Garrett, R. Singh, A. Sweeney, C. Rosenberg, D. Parachiv, and T. Okafo
Early Administration of Antibiotics Does Not Shorten Time to Clinical Stability in Patients With Moderate-to-Severe Community-Acquired Pneumonia
Chest, November 1, 2003; 124(5): 1798 - 1804.
[Abstract] [Full Text] [PDF]

Home page
 ThoraxHome page
M D Eisner, P Parsons, M A Matthay, L Ware, and K Greene
Plasma surfactant protein levels and clinical outcomes in patients with acute lung injury
Thorax, November 1, 2003; 58(11): 983 - 988.
[Abstract] [Full Text] [PDF]

Home page
 Antimicrob. Agents Chemother.Home page
H.-P. Cheng, L. K. Siu, and F.-Y. Chang
Extended-Spectrum Cephalosporin Compared to Cefazolin for Treatment of Klebsiella pneumoniae-Caused Liver Abscess
Antimicrob. Agents Chemother., July 1, 2003; 47(7): 2088 - 2092.
[Abstract] [Full Text] [PDF]

Home page
 Obstet GynecolHome page
J. Bailit and J. Garrett
Comparison of Risk-Adjustment Methodologies for Cesarean Delivery Rates
Obstet. Gynecol., July 1, 2003; 102(1): 45 - 51.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
A. L. Rosenberg, T. P. Hofer, C. Strachan, C. M. Watts, and R. A. Hayward
Accepting Critically Ill Transfer Patients: Adverse Effect on a Referral Center's Outcome and Benchmark Measures
Ann Intern Med, June 3, 2003; 138(11): 882 - 890.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
A. Tremblay and V. Bandi
Impact of Body Mass Index on Outcomes Following Critical Care
Chest, April 1, 2003; 123(4): 1202 - 1207.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
J. Y. Gabor, A. B. Cooper, S. A. Crombach, B. Lee, N. Kadikar, H. E. Bettger, and P. J. Hanly
Contribution of the Intensive Care Unit Environment to Sleep Disruption in Mechanically Ventilated Patients and Healthy Subjects
Am. J. Respir. Crit. Care Med., March 1, 2003; 167(5): 708 - 715.
[Abstract] [Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
C. W.T. Sawchuk, D. T. Wong, B. P. Kavanagh, and S. C. Siu
Transthoracic echocardiography does not improve prediction of outcome over APACHE II in medical-surgical intensive care: [L'echocardiographie transthoracique n'ameliore pas la prediction des resultats par rapport au score APACHE II a l'unite des soins intensifs medicaux chirurgicaux]
Can J Anesth, March 1, 2003; 50(3): 305 - 310.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. Pietrantoni, O. A. Minai, N. C. Yu, J. R. Maurer, M. T. Haug III, A. C. Mehta, and A. C. Arroliga
Respiratory Failure and Sepsis Are the Major Causes of ICU Admissions and Mortality in Survivors of Lung Transplants
Chest, February 1, 2003; 123(2): 504 - 509.
[Abstract] [Full Text] [PDF]

Home page
 Anesth. Analg.Home page
E. L. Bloomfield
The Impact of Economics on Changing Medical Technology with Reference to Critical Care Medicine in the United States
Anesth. Analg., February 1, 2003; 96(2): 418 - 425.
[Full Text] [PDF]

Home page
 Card Surg AdultHome page
V. A. Ferraris and S. P. Ferraris
Risk Stratification and Comorbidity
Card. Surg. Adult, January 1, 2003; 2(2003): 187 - 224.
[Full Text]

Home page
 ChestHome page
G. S. Martin, E. W. Ely, F. E. Carroll, and G. R. Bernard
Findings on the Portable Chest Radiograph Correlate With Fluid Balance in Critically Ill Patients
Chest, December 1, 2002; 122(6): 2087 - 2095.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
R. G. Brower, M. Matthay, and D. Schoenfeld
Meta-analysis of acute lung injury and acute respiratory distress syndrome trials
Am. J. Respir. Crit. Care Med., December 1, 2002; 166(11): 1515 - 1517.
[Full Text] [PDF]

Home page
 JAMAHome page
P. J. Pronovost, D. C. Angus, T. Dorman, K. A. Robinson, T. T. Dremsizov, and T. L. Young
Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A Systematic Review
JAMA, November 6, 2002; 288(17): 2151 - 2162.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Med. Inform. Assoc.Home page
D. G. T. Arts, N. F. de Keizer, and G.-J. Scheffer
Defining and Improving Data Quality in Medical Registries: A Literature Review, Case Study, and Generic Framework
J. Am. Med. Inform. Assoc., November 1, 2002; 9(6): 600 - 611.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
D. P. Sulmasy and J. M. McIlvane
Patients' Ratings of Quality and Satisfaction With Care at the End of Life
Arch Intern Med, October 14, 2002; 162(18): 2098 - 2104.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
G. Saydain, A. Islam, B. Afessa, J. H. Ryu, J. P. Scott, and S. G. Peters
Outcome of Patients with Idiopathic Pulmonary Fibrosis Admitted to the Intensive Care Unit
Am. J. Respir. Crit. Care Med., September 15, 2002; 166(6): 839 - 842.
[Abstract] [Full Text]

Home page
 Am. J. Respir. Crit. Care Med.Home page
D. C. Angus, T. J. Marrie, D. S. Obrosky, G. Clermont, T. T. Dremsizov, C. Coley, M. J. Fine, D. E. Singer, and W. N. Kapoor
Severe Community-acquired Pneumonia: Use of Intensive Care Services and Evaluation of American and British Thoracic Society Diagnostic Criteria
Am. J. Respir. Crit. Care Med., September 1, 2002; 166(5): 717 - 723.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
D. A. Chung, L. D. Sharples, and S. A.M. Nashef
A case-control analysis of readmissions to the cardiac surgical intensive care unit
Eur. J. Cardiothorac. Surg., August 1, 2002; 22(2): 282 - 286.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
W. A. Ghali, P. D. Faris, P. D. Galbraith, C. M. Norris, M. J. Curtis, L. D. Saunders, V. Dzavik, L. B. Mitchell, M. L. Knudtson, and for the Alberta Provincial Project for Outcome Ass
Sex Differences in Access to Coronary Revascularization after Cardiac Catheterization: Importance of Detailed Clinical Data
Ann Intern Med, May 21, 2002; 136(10): 723 - 732.
[Abstract] [Full Text] [PDF]

Home page
 NEJMHome page
B. E. Ostrowsky, C. Whitener, H. K. Bredenberg, L. A. Carson, S. Holt, L. Hutwagner, M. J. Arduino, and W. R. Jarvis
Serratia marcescens Bacteremia Traced to an Infused Narcotic
N. Engl. J. Med., May 16, 2002; 346(20): 1529 - 1537.
[Abstract] [Full Text] [PDF]

Home page
 Arch Intern MedHome page
R.-W. Tsay, L. K. Siu, C.-P. Fung, and F.-Y. Chang
Characteristics of Bacteremia Between Community-Acquired and Nosocomial Klebsiella pneumoniae Infection: Risk Factor for Mortality and the Impact of Capsular Serotypes as a Herald for Community-Acquired Infection
Arch Intern Med, May 13, 2002; 162(9): 1021 - 1027.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
R. L. Mehta, M. T. Pascual, C. G. Gruta, S. Zhuang, and G. M. Chertow
Refining Predictive Models in Critically Ill Patients with Acute Renal Failure
J. Am. Soc. Nephrol., May 1, 2002; 13(5): 1350 - 1357.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. Junker, J. E. Zimmerman, C. Alzola, E. A. Draper, and D. P. Wagner
A Multicenter Description of Intermediate-Care Patients* : Comparison With ICU Low-Risk Monitor Patients
Chest, April 1, 2002; 121(4): 1253 - 1261.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
C. A. Sirio, K. Tajimi, N. Taenaka, Y. Ujike, K. Okamoto, and H. Katsuya
A Cross-Cultural Comparison of Critical Care Delivery : Japan and the United States
Chest, February 1, 2002; 121(2): 539 - 548.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
2-Month Mortality and Functional Status of Critically Ill Adult Patients Receiving Prolonged Mechanical Ventilation
Chest, February 1, 2002; 121(2): 549 - 558.
[Abstract] [Full Text] [PDF]

Home page
 Arch SurgHome page
W. A. Knaus
APACHE 1978-2001: The Development of a Quality Assurance System Based on Prognosis: Milestones and Personal Reflections
Arch Surg, January 1, 2002; 137(1): 37 - 41.
[Full Text] [PDF]

Home page
 J. Am. Soc. Nephrol.Home page
G. Contreras, G. Garces, A. A. Quartin, C. Cely, M. A. LaGatta, G. A. Barreto, D. Roth, and E. Gomez
An Epidemiologic Study of Early Renal Replacement Therapy after Orthotopic Liver Transplantation
J. Am. Soc. Nephrol., January 1, 2002; 13(1): 228 - 233.
[Abstract] [Full Text] [PDF]

Home page
 ANN INTERN MEDHome page
E. W. Ely, A. P. Wheeler, B. T. Thompson, M. Ancukiewicz, K. P. Steinberg, G. R. Bernard, and for the Acute Respiratory Distress Syndrome Networ
Recovery Rate and Prognosis in Older Persons Who Develop Acute Lung Injury and the Acute Respiratory Distress Syndrome
Ann Intern Med, January 1, 2002; 136(1): 25 - 36.
[Abstract] [Full Text] [PDF]

Home page
 Arch. Dis. Child.Home page
S M Tibby, I A Murdoch, F Shann, and G Pearson
Calibration of the paediatric index of mortality score for UK paediatric intensive care Authors' reply
Arch. Dis. Child., January 1, 2002; 86(1): 65 - 66.
[Full Text] [PDF]

Home page
 BloodHome page
J. Zweigner, H.-J. Gramm, O. C. Singer, K. Wegscheider, and R. R. Schumann
High concentrations of lipopolysaccharide-binding protein in serum of patients with severe sepsis or septic shock inhibit the lipopolysaccharide response in human monocytes
Blood, December 15, 2001; 98(13): 3800 - 3808.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
B. A. Dubaybo
Microalbuminuria : Simple, Inexpensive, and Dynamic Marker of Critical Illness
Chest, December 1, 2001; 120(6): 1769 - 1770.
[Full Text] [PDF]

Home page
 ChestHome page
A. El-Solh, P. Sikka, E. Bozkanat, W. Jaafar, and J. Davies
Morbid Obesity in the Medical ICU
Chest, December 1, 2001; 120(6): 1989 - 1997.
[Abstract] [Full Text] [PDF]

Home page