Chronic Health APACHE

This article is about Chronic Health in the context of the APACHE score, see Comorbid Diagnosis for info on the comorbidities we collect, and Charlson Comorbidity Index for the Charlson comorbidities that are also used for the Alert score.

This value is now derived from ICD10 diagnoses, see Change for Apache Chronic to ICD10 from separate variable for details.

 

 

 

 

Legacy Content

This page contains Legacy Content.

• Explanation: This is a legacy data field, its DataElementEndDate is in the past.
• Successor: No successor was entered

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Data Element (edit)
Field Name:	Ap_Chronic
CCMDB Label:	Chronic
CCMDB tab:	Apache
Table:	L_Log table
Data type:	string
Length:	30
Program:	CC
Created/Raw:	Raw
Start Date:
End Date:	2022-02-17
Sort Index:	56

Specific chronic pre-existing conditions used for APACHE score.

• SMW

Legacy implementation right in the table

• Cargo

• Categories

• Forms

This value is used in conjunction with Admit Type for APACHE II to calculate the Chronic_Health_Score, one of the components of the .

To be considered to be a chronic disease, the chronic condition must have been documented as present before current hospitalization.

Chronic Health Table

Dropdown in CCMDB.accdb	Orignial APACHE II CH list with definitions
1. Immunocompromized (this category includes the following: Metastatic Cancer, Hematological Malignancy-Lymphoma, Leukemia and also AIDS)	(this is applicable to items 1-5. Receiving therapy that suppresses resistance to infection such as: at least one of the following: ≥15mg/kg/day hydrocortisone >3 mg/kg’day of methylprednisolone for >5 days (for entire LOS if pts LOS is less than 5 days). ≥10 mg prednisone Chemotherapy Radiation therapy Post BMT (Bone Marrow Transplant) sufficiently advanced disease to suppress resistance to infection Include patients on methotrexate or cyclophosphamide, etc. (for autoimmune disorders) pt is on immunosuppressive drugs (RA or SLE pts) ExpandList of immunosuppressive drugs    Used to treat an increasing variety of conditions: immune-mediated (RA, UC, Crohn's, lupus, MS, psoriasis, etc); after organ transplant. Only considered immunosuppressive if given systemically (po, im or iv) Corticosteroids (unlike all the others, these only count if > a given daily dose and used for at least 2 weeks prior to admission) Dexamethasone: >0.25 mg/day Hydrocortisone: >40 mg/day Prednisone (methyl-prednisolone): >10 mg/day Prednisolone: >8 mg/day Cancer chemotherapy -- includes any agents, if received within the past 6 months Nonsteroidal immunosuppressives -- includes any of these, if received within the past 1 month Abatacept (Orencia) Azathioprine (Imuran) Adalimumab (Humira) Anakinra (Kineret) Basiliximab (Simulect) Certolizumab (Cimzia) Cyclophosphamide (Cytoxan) Cyclosporine Daclizumab (Zinbryta) Etanercept (Enbrel) Everolimus (Afinitor, Zortress) Golimumag (Simponi) Infliximab (Remicade) Ixekizumab (Taltz) Leflunomide (Arava) Lenalidomide Methotrexate Mycophenolate (CellCept) Natalizumab (Tysabri) Rituximab (Rituxan) Secukinumab (Cosentyx) Sirolimus (Rapasumne) Tacrolimus (Prograf) Tocilizumab (Actemra) Tofacitinib (Xeljanz) Ustekinumab (Stelara) Vedolizumab (Entyvio) Do not include hydroxychloroquine - as per task meeting 2022-04-20 it is an immune modulator, but not very immunosuppressive
2. Met Cancer sufficiently advanced disease to suppress resistance to infection
3. HematMalign e.g. Lymphoma or Leukemia sufficiently advanced disease to suppress resistance to infection
4. AIDS
5. CRF-severe	Receiving Chronic out-patient hemo- or peritoneal dialysis prior to hospital admission.
6. Liver-severe	any of: biopsy proven cirrhosis & previously documented portal hypertension past episodes of GI bleeds related to portal hypertension or varicies hepatic failure or encephalopathy or coma
7. Lung severe	any of the following that results in severe exercise restriction (i.e. unable to climb stairs or perform household duties): COPD-severe Restrictive lung disease-severe Vascular disease-severe or any of the following documented chronic hypoxia or hypercapnia, secondary polycythemia Pulmonary HTN on home O2 (this does not include home bipap or cpap unless the pt also has one of the other listed conditions)Bipap or cpap if only for airway does not imply lung disease. Cpap for obstructive sleep apnea is just constant positive air pressure to keep the airway open during sleep. Not usually used with oxygen. Ventilator dependent Does being on bipap or cpap for obesity be considered restrictive lung disease severe?--MWaschuk 14:31, 2012 May 28 (CDT) There may be an element of restrictive lung disease with obesity as the lung cannot always fully expand related to pressure on the diaphragm of a morbidly obese pt. To be considered true restrictive lung disease however, this must result in impaired ventilatory function. Most obese pts on bipap are only on bipap at night to maximize the airway. To call this severe restrictive lung disease is incorrect. If they are on home O2 during the day as well or have any of the above issues like documented hypoxia or hypercapnea, then this would be considered severe restrictive lung disease. Bipap at night alone is not sufficient evidence of severe restrictive lung disease even if the pt is obese. --LKolesar 07:16, 2012 May 29 (CDT)
8. CVS min exert	Class 4 Angina - pain @ rest or with minimal exertion
9. No Chronic Health

Implementation

• Chronic Health is stored as a single-choice dropdown in CCMDB.accdb and Centralized data.mdb
• There is an additional option "0HasChronic"; this can not be selected in CCMDB.accdb but is used in Centralized data.mdb for old records that were imported from TMSX and MedTMS where the detailed data was not collected

ICD10

We are moving to derive this concept from APACHE Comorbidities in ICD10 codes.

Change log

• 2022-02-17 - decided to stop collecting this and apply Change for Apache Chronic to ICD10 from separate variable
• 2022-02-09 - Julie, Tina and Allan discussed Julie's most recent analysis of this; there are still many differences in dx vs chronic, with higher and lower counts for different components. Allan quotes a paper that acknowledges this difference in count, but that the Apache score ends up similar. Question raised: is the saving of time in no longer collecting this as a field worth the loss of accuracy.
• 2021-04-22 - preliminary analysis of how deriving this from ICD10 would compare with previous manual collection; many differences; Tina emailed Allan and Julie, more to come
• 2021-04-19 - Added Drug-induced immunosuppression since that component of this code was not previously collected comprehensively
• 2021-03-11 - The list of drugs is at Template:List of immunosuppressive drugs.
• 2021-02-22 - AG sent email to Julie and Tina to get back to this change.
• 2018-11-28 - AG confirmed that this is an option

Legacy

• when sent for import into TMSX and MedTMS the chronic health score was translated into yes or no; when we moved to Centralized data.mdb these were imported as "0HasChronic"
• the fields were made into a pick list of 9 items that belong to one of the five APACHE II Chronic Health categories because Medicine wanted to use both APACHE II and SAPS II on Medicine patients. SAPS II and APACHE II scored these same chronic health items differently. SAPS is no longer collected.

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