Hershman M J, Cheadle W G, Kuftinec D, Polk H C, George C D
University of Louisville, Kentucky.
Injury. 1988 Jul;19(4):263-6. doi: 10.1016/0020-1383(88)90042-3.
Injury is an important cause of both morbidity and mortality, particularly in the young. Scoring systems have been developed to establish guidelines of transfer and compare patient outcome, but no scoring system as yet has been constructed that focuses upon immune capability of these patients. We report an outcome predictive score (OPS) which appears to distinguish good outcome from sepsis in patients who survive, and between patients with sepsis who survive from patients with sepsis who die. The score is based on (1) Injury severity score (ISS) expressed as percentage of the 50 per cent lethal dose of injury for age (%LD50), (2) Degree of bacterial contamination at initial injury, (3) The patient's monocyte DR antigen expression. Fifty-one severely injured patients were divided into three groups: (1) A group without infection (N = 15), (2) A major sepsis group which survived (N = 24), (3) A group who died (N = 12). There was no difference between the ISS of these groups. The mean OPS of the good outcome group was significantly less than the mean OPS of both the septic (P less than 0.0002) and dead (P less than 0.00001) groups. The mean OPS of the septic group was also significantly less than the mean of the group that died (P less than 0.002). Identification of high risk patients may be important to determine priority of patient care and to institute additional therapeutic measures.
损伤是发病和死亡的重要原因，在年轻人中尤为如此。已经开发出评分系统来制定转诊指南并比较患者的预后，但尚未构建出专注于这些患者免疫能力的评分系统。我们报告了一种预后预测评分（OPS），它似乎能够区分存活患者中预后良好与发生脓毒症的情况，以及区分存活的脓毒症患者与死亡的脓毒症患者。该评分基于：（1）损伤严重程度评分（ISS），以年龄的50%致死剂量损伤（%LD50）的百分比表示；（2）初始损伤时的细菌污染程度；（3）患者单核细胞DR抗原表达。51名重伤患者被分为三组：（1）无感染组（N = 15）；（2）存活的严重脓毒症组（N = 24）；（3）死亡组（N = 12）。这些组的ISS没有差异。预后良好组的平均OPS显著低于脓毒症组（P < 0.0002）和死亡组（P < 0.00001）的平均OPS。脓毒症组的平均OPS也显著低于死亡组的平均OPS（P < 0.002）。识别高危患者对于确定患者护理的优先级和采取额外的治疗措施可能很重要。
