ARF (APACHE)

Information on this page applies to the APACHE II ARF dropdown only; for the diagnosis code see any one of the several ICD10 codes for types/causes of ARF.

Data Element (edit)
Field Name:	Ap_ARF
CCMDB Label:	ARF
CCMDB tab:	not stated
Table:	L_Log table
Data type:	number
Length:	single
Program:	CC
Created/Raw:	Raw
Start Date:	1988-07-11
End Date:	2300-01-01
Sort Index:	77

The ARF checkbox is checked/true if patient is in Acute Renal Failure as per the APACHE definition.

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Legacy implementation right in the table

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Additional Info

• In original APACHE II there were no criteria given for what constitutes Acute Renal Failure. So, we came up with criteria based on serum creatinine and urine output. As we implemented ICD-10, we decided to use a uniform definition, i.e. the same one here as for the various ICD10 diagnoses of Acute Renal Failure -- i.e. the KDIGO guidelines.
• (see historical info below as to criteria that was used for ARF)

Coding Guideline

For critical care only: The ARF (Acute Renal Failure) dropdown for APACHE defaults to "enter"; you won't be able to send unless you change it to one of the following:

• Choose "yes" if any one or more of the following are true (these are the KDIGO guidelines)KDIGO guidelines:
  • Increase in serum creatinine by 26 micromoles/L or more within 48 hours
  • Increase in serum creatinine to 1.5 times baseline or more within the last 7 days
  • Urine output less than 0.5 mL/kg/hour for 6 hours

Choose "no" if the pt

• has CRF in comorbids or
• does not meet the above "yes" conditions.

The new coding guidelines for choosing “yes” in ARF for apache are based upon the KDIGO guidelines for defining acute kidney injury Stage 1. The stage 1 guideline would apply to the diagnosis of ARF in our diagnostic section, however, based upon my understanding of apache, it does not make sense in this scoring system. My understanding of apache is that it is a predictor of hospital mortality, it is for severity of illness for critically ill patients. Where is the prognostic value if we put in every patient that qualifies as stage 1 AKI in the apache? It would make our apache scores increase dramatically with this change as many patients have some kidney compromise in the ICU. Perhaps we should be looking at stage 2 or 3 AKI for the apache score section. Just wondering about this. What do you think? - -See link for background of Apache II on wiki. --Nov 26, 2018 -Laura K AG REPLY --- to be discussed at next Task meeting

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Data Use

ARF is one component used to generate the APACHE II score.

Specifically, double points are assigned for the Creatinine score if the patient has ARF . (see APACHE Scoring table#Physiological Variables)

Data Integrity Checks (automatic list)

	App	Status
Can't check ICD10 ARF vs APACHE ARF	CCMDB.accdb	declined
Query check ApARF CRF	CCMDB.accdb	retired
Query check ICD10 ESRD vs AP ARF	not entered	retired

See also

see Category:Renal Problem (old) for other renal problems

Historical

• there were criteria for ARF in the APACHE II user manual 1986, Ver 1.0, that we applied when we started in 1988, they were:
  • creatinine PLUS oliguria. Oliguria was defined as: urine output of less than 135 cc over a consecutive 8 hr period in the first 24 hrs of ICU admission.
  • Copy of this APACHE II User Manual can be found in the article archives library located: HSC in JJ387.