Version May 2024
| Variable | Range | Points |
| Patient age | <40 years | 0 |
| 40-59 years | 7 | |
| 60-69 years | 12 | |
| 70-74 years | 15 | |
| 75-79 years | 16 | |
| ≥80 years | 18 | |
| Type of admission | Scheduled surgery | 0 |
| Medical | 6 | |
| Unscheduled surgery | 8 | |
| Temperature | <39°C, <102.2°F | 0 |
| ≥39°C, ≥102.2°F | 3 | |
| Systolic blood pressure | ≥200 mmHg | 2 |
| 100-199 mmHg | 0 | |
| 70-99 mmHg | 5 | |
| <70 mmHg | 13 | |
| Heart rate | ≥160 bpm | 7 |
| 120-159 bpm | 4 | |
| 70-119 bpm | 0 | |
| 40-69 bpm | 2 | |
| <40 bpm | 11 | |
| Glasgow coma scale | 14-15 | 0 |
| 11-13 | 5 | |
| 9-10 | 7 | |
| 6-8 | 13 | |
| <6 | 26 | |
| Urine output | ≥1 L/24 hr | 0 |
| 0.5-0.999 L/24 hr | 4 | |
| <0.5 L/24 hr | 11 | |
| White blood cell count | <1000 /mm3 | 12 |
| 1000-19,000 /mm3 | 0 | |
| ≥20,000 /mm3 | 3 | |
| Blood urea nitrogen | ≥30 mmol/L, ≥84 mg/dL | 10 |
| 10-29.9 mmol/L, 28-83 mg/dL | 6 | |
| <10 mmol/L, <28 mg/dL | 0 | |
| Potassium level | <3 mEq/L | 3 |
| 3-4.9 mEq/L | 0 | |
| ≥5 mEq/L | 3 | |
| Sodium level | <125 mEq/L | 5 |
| 125-144 mEq/L | 0 | |
| ≥145 mEq/L | 1 | |
| Bicarbonate level | <15 mEq/L | 6 |
| 15-19 mEq/L | 3 | |
| ≥20 mEq/L | 0 | |
| Bilirubin level | <4 mg/dL, <68.4 micromol/L | 0 |
| 4-5.9 mg/dL, 68.4-102.5 micromol/L | 4 | |
| ≥6 mg/dL, ≥102.6 micromol/L | 9 | |
| PaO2/FiO2 (if mechanically ventilated or receiving CPAP) | <100 mmHg | 11 |
| 100-199 mmHg | 9 | |
| ≥200 mmHg | 6 | |
| AIDS | Yes | 17 |
| No | 0 | |
| Metastatic carcinoma | Yes | 9 |
| No | 0 | |
| Hematologic malignancy | Yes | 10 |
| No | 0 |
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