Pilz G, Kääb S, Kreuzer E, Werdan K
Medizinische Klinik I, Klinikum Grosshadern, Ludwig-Maximilians-Universität, München, BRD.
Infusionsther Transfusionsmed. 1993 Apr;20 Suppl 1:6-14; discussion 15.
Since sepsis is a major cause of mortality after cardiac surgery, early identification of the patients at risk of developing septic complications is of considerable importance. In the present study on 110 patients after elective heart surgery, we, therefore, examined scoring systems as well as various single parameters with regard to an early prediction of septic complications. In a first step, the Elebute score definition for postoperative sepsis in general surgery patients (score > or = 12) could be confirmed for cardiac surgery patients as well. Septic complications, defined as an Elebute score > or = 12 on > or = 2 days, occurred in 16 patients and were associated with a significantly worse prognosis than in non-septic patients (mortality 69 vs. 1%). Consequently, other more practicable parameters were investigated: five additional scores (APACHE II, Goris, HIS, SAPS, SSS) were comparable and superior to plasma levels of elastase and neopterin, haemodynamic data, and clinical parameters in predicting septic complications as early as by the 1st postoperative day. For reasons of practicability and availability, the APACHE II score (predictive values: positive 86%, negative 96%, Youden index 0.73; diagnostic cut off point: > or = 19 on the 1st postoperative day) seemed to be best suited. Therefore, this was further investigated within a consecutive prospective study (independent group of 106 patients) which confirmed an APACHE II score > or = 19 as discriminating criterion (mortality 36 vs 0%). Thus, the APACHE II score may be useful for prospective screening, with the intention to treat, of patients after cardiac surgery who are at risk of postoperative septic complications.
由于脓毒症是心脏手术后死亡的主要原因，因此早期识别有发生脓毒症并发症风险的患者具有相当重要的意义。在本项针对110例择期心脏手术后患者的研究中，我们因此检查了评分系统以及各种单一参数，以早期预测脓毒症并发症。第一步，普通外科患者术后脓毒症的Elebute评分定义（评分≥12）在心脏手术患者中也得到了证实。脓毒症并发症定义为连续≥2天Elebute评分≥12，16例患者出现该并发症，与非脓毒症患者相比，其预后明显更差（死亡率分别为69%和1%）。因此，我们研究了其他更实用的参数：另外五个评分（APACHE II、Goris、HIS、SAPS、SSS）在预测术后第1天的脓毒症并发症方面具有可比性，且优于弹性蛋白酶和新蝶呤的血浆水平、血流动力学数据及临床参数。出于实用性和可获得性的考虑，APACHE II评分（预测值：阳性86%，阴性96%，约登指数0.73；诊断临界值：术后第1天≥19）似乎最为合适。因此，在一项连续的前瞻性研究（106例患者的独立队列）中对此进行了进一步研究，该研究证实APACHE II评分≥19可作为鉴别标准（死亡率分别为36%和0%）。因此，APACHE II评分可能有助于对有术后脓毒症并发症风险的心脏手术后患者进行前瞻性筛查，以便进行治疗。
