InfusionFox
ICU severity score · Dogs

APPLE-full illness severity

10-variable Acute Patient Physiologic and Laboratory Evaluation score for hospitalized dogs (Hayes 2010). Creatinine, WBC, albumin, SpO₂, total bilirubin, mentation, respiratory rate, age, fluid score (FAST/TFAST), and lactate produce a 0–80 score that maps to predicted hospital mortality. Cutoff >30/80: specificity 89%, sensitivity 81%. AUROC 0.93/0.91 (construction/validation).

Just need a quick stratification on glucose, albumin, lactate, platelets, and mentation? Use the 5-variable APPLE-fast score instead.

Chemistry

Use the most abnormal value in the first 24 h after admission.

Hematology

Vitals & physical

If pulse oximetry wasn't performed and physical exam didn't prompt assessment, the original paper allows assigning zero points (i.e. enter a value in the 98–100 referent range).

Mentation

Assessed at admission, before sedation or analgesia.

Fluid score (FAST / TFAST)

Per Boysen et al. JAVMA 2004. If FAST/TFAST wasn't performed and physical exam didn't prompt it, the original paper allows assigning zero.

Scoring notes — counterintuitive items

Five items in the APPLE-full rubric are clinically counterintuitive. They are preserved exactly as Hayes 2010 published them, because the multivariable regression assigns coefficients reflecting mortality variance not already explained by the other nine variables, not the marginal univariable association. The paper discusses this on page 11.

  • Creatinine 0–0.62 mg/dL (0–55 umol/L) → 0 pts (referent). Lowest-risk band sits BELOW the normal canine creatinine range. The normal range (0.63–1.35 mg/dL) scores 1.
  • WBC <5.1 ×10⁹/L → 9 pts. Leukopenia is the highest-scoring WBC band. In an ICU dog this tracks with severe sepsis with consumption, immune-mediated processes, parvovirus, etc.
  • Albumin 31–32 g/L → 9 pts (higher than <26 g/L which scores 6). Multivariable artifact specifically called out in the paper.
  • Total bilirubin non-monotonic: 0.24–0.46 → 6, 0.47–0.93 → 4, >0.93 → 3 mg/dL. Mild bilirubinemia carries the most independent risk; severe bilirubinemia is largely captured by correlated variables.
  • Respiratory rate 49–60 bpm → 6 pts (higher than >60 bpm → 5). Mild–moderate tachypnea outweighs frank tachypnea in the multivariable context.
Awaiting input

Enter all 10 variables (creatinine, WBC, albumin, SpO₂, bilirubin, mentation, respiratory rate, age, fluid score, and lactate) to compute the APPLE-full score.