Sepsis score and acute-phase protein response as predictors of outcome in septic surgical patients.
In a series of 135 patients with severe surgical infections, we determined the sepsis score and the plasma level of the acute-phase proteins alpha-1-acid glycoprotein, alpha 1-antitrypsin, complement factor B, and C3. The initial sepsis score was a strong determinant of survival: in survivors it was significantly lower than in nonsurvivors. Only 8% of patients with a sepsis score above 20 survived. At the onset of severe sepsis, the plasma levels of all four acute-phase proteins were significantly lower in nonsurvivors. A significant elevation of C3a levels in the plasma of both surviving and nonsurviving patients indicated marked consumption of complement components in all patients with severe sepsis. A linear equation was developed to predict survival: sepsis index of survival (SIS) % = 121 + 0.26 (complement factor B) + 0.36 (alpha-1-acid glycoprotein)-6 (sepsis score). Based on our analysis, at the onset of severe sepsis, an SIS of 50% or more can correctly predict 88% of survivors and an SIS less than 50% can correctly predict 86% of nonsurvivors several days in advance of clinical outcome.
D000328:Adult; D001424:Bacterial Infections / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D003176:Complement C3 / Q000032:analysis; D011415:Complement Factor B / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009961:Orosomucoid / Q000032:analysis; D011379:Prognosis; D000515:alpha 1-Antitrypsin / Q000032:analysis
D003176:Complement C3; D009961:Orosomucoid; D000515:alpha 1-Antitrypsin; D011415:Complement Factor B