Pilz G, Kääb S, Kreuzer E, Werdan K
Herzchirurgische Klinik, Klinikum Grosshadern der Universität München, Germany.
Infection. 1994 Jan-Feb;22(1):8-17. doi: 10.1007/BF01780757.
In 110 patients undergoing elective heart surgery on extracorporeal circulation, various parameters were studied regarding the early assessment of septic complications. In a first step, the Elebute score definition for postoperative sepsis validated in general surgery patients (score > or = 12) could be confirmed in an extended form (> or = 12 on > or = 2 days) for cardiac surgery patients. According to this definition (overall classification accuracy for clinically defined sepsis-related mortality: 94%), septic complications occurred in 16 patients and were associated with a significantly worse prognosis than in non-septic patients (mortality 69% vs. 1%, p < 0.0001). In contrast, SIRS (best classification criterion: positive on > or = 3 days) displayed a lower specificity for clinically defined sepsis-related mortality, at least during the early postoperative course (accuracy: 67%). Based on the Elebute score classification, other more practicable parameters were investigated regarding their usefulness for an early sepsis risk assessment in post cardiac surgical patients. Five additional severity scores (APACHE II, MOF-Goris, HIS, SAPS, SSS) were comparable (ROC area: 0.94 to 0.96) and superior to plasma PMN-elastase and neopterin, haemodynamics and clinical parameters in predicting the risk for septic complications as early as by the first postoperative day.
在110例接受体外循环择期心脏手术的患者中，研究了各种参数以进行脓毒症并发症的早期评估。第一步，在普通外科患者中验证的术后脓毒症的Elebute评分定义（评分≥12），在心脏手术患者中可扩展形式（≥2天内评分≥12）得到证实。根据该定义（临床定义的脓毒症相关死亡率的总体分类准确率：94%），16例患者发生了脓毒症并发症，与非脓毒症患者相比，其预后明显更差（死亡率69%对1%，p<0.0001）。相比之下，全身炎症反应综合征（最佳分类标准：≥3天呈阳性）对临床定义的脓毒症相关死亡率显示出较低的特异性，至少在术后早期病程中如此（准确率：67%）。基于Elebute评分分类，研究了其他更实用的参数对心脏手术后患者早期脓毒症风险评估的有用性。另外五个严重程度评分（急性生理与慢性健康状况评分系统II、多器官功能障碍综合征-戈里斯评分、医院感染评分、简化急性生理学评分、简化脓毒症评分）具有可比性（受试者工作特征曲线下面积：0.94至0.96），并且在预测术后第一天就出现脓毒症并发症的风险方面优于血浆中性粒细胞弹性蛋白酶和新蝶呤、血流动力学及临床参数。
