APACHE versus SOFA scoring systems

OVERVIEW

  • APACHE and SOFA are scoring systems that are commonly used in intensive care
  • APACHE = Acute Physiology, Age and Chronic Health Evaluation (I-IV)
  • SOFA = Sequential Organ Failure Assessment 

APACHE VERSUS SOFA

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FeatureAPACHESOFA
BasisThree factors that influence outcome in critically ill patients
  1. chronic background disease
  2. patient reserve
  3. severity of acute illness
Degree of organ dysfunction is related to acute illness(initially based on sepsis related organ dysfunction but later validated for organ dysfunction not related to sepsis)
ScorePhysiological variable, chronic health conditions, emergency / elective admissions, and post-operative / non-operative admissionsDefined score (1-4) for each of six organ systems
  1. Respiratory
  2. CVS
  3. CNS
  4. renal
  5. Coagulation
  6. Liver
Scoring durationBased on the most abnormal measurements in the first 24 hours of ICU stayDaily scoring of individual and composite scores possible during course of ICU stay
Population outcome comparisonStandardized mortality ratios can be used for large patient populationsNo predicted mortality algorithm.
In general, higher SOFA score is associated with worse outcome.Treatment effects on SOFA
Individual patient outcomesNot possible to predict individual patient outcome or response to therapyResponse of organ dysfunction to therapy can be followed over time

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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