Early prediction of septic complications after cardiac surgery by APACHE II score.
In 110 patients admitted to the intensive care unit after cardiac surgery, daily monitoring [clinical parameters, cardiac index (CI), left ventricular stroke work index (LVSWI) and APACHE II score] was performed in regard to its usefulness in the early prediction of septic complications, a major cause of postoperative mortality. Septic complications (defined as Elebute sepsis score of > or = 12 on > or = 2 days) occurred in 16 patients and were associated with a significantly worse prognosis (mortality 69% vs 1%, P < 0.0001) than was seen in patients without sepsis. While preoperative APACHE II score values did not differentiate between the patients with an uneventful postoperative course and those with septic complications, patients who ultimately developed septic complications had significantly (P < 0.001) higher scores as early as on the evening of the operation day ("day 0"). In addition, in contrast to patients without sepsis, whose scores dropped markedly (P < 0.001) between day 0 and day 1, patients with septic complications invariably had high scores. Compared to single parameters (fever, leucocyte count, CI, LVSWI), the APACHE II score proved to be superior in differentiating between patients who developed sepsis and those who did not. A score of 19 or more on the 1st postoperative day had a sensitivity of 75%, a specificity of 98%, a Youden index of 0.73, a positive predictive value of 86%, and a negative predictive value of 96% in regard to prediction of septic complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Kreuzer
E
E
Department of Cardiac Surgery, Grosshadern University Hospital, Munich, FRG.
Kääb
S
S
Pilz
G
G
Werdan
K
K
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index