Immunological surrogate parameters in a prognostic model for multi-organ failure and death.
OBJECTIVE
To assess the ability of clinical or biochemical parameters to predict outcome (survival or non-survival; severe or moderate/no complication) using multiple regression analyses.


METHODS
Prospective, descriptive cohort study with no interventions


METHODS
12 surgical intensive care units of university hospitals and large community hospitals; four medical school research laboratories in eight European countries


METHODS
128 surgical patients with major intra-abdominal surgery admitted for at least two days to an intensive care unit


METHODS
Prediction of complications or survival based on analysis of clinical (Multiple Organ Dysfunction Score, Multi-Organ-Failure Score, Acute Physiology and Chronic Health Evaluation II scores) and immunological (plasma levels of endotoxin, endotoxin neutralizing capacity, IL-6, IL-8, cell associated IL-8, Fc-receptor polymorphism, soluble CD-14) parameters, with comparison of predicted and actual outcomes.


RESULTS
APACHE II, MODS score, MOF score, platelets, IL-6, IL-8, ENC, cell ass. IL-8 were significantly different between survivors and non-survivors and patients with/without severe complications by univariate analysis. By multivariate analysis only MOF, MODS score, IL-6, platelets, comorbidity predicted complications with a sensitivity of 82% and a specificity of 87%. Multivariate analysis demonstrated that only APACHE II score, plasma IL-8 and complications predicted death (sensitivity 84%; specificity 90%).


CONCLUSIONS
Immunological surrogate parameters may predict complications and death of surgical ICU patients. The use of several parameters may add to increase sensitivity and specificity in a prognostic model.
Holzheimer
R G
RG
Medical Faculty University Halle-Wittenberg, Germany. gresser.holzheimer@t-online.de.
Capel
P
P
Cavaillon
J M
JM
Cainzos
M
M
Frileux
P
P
Haupt
W
W
Marie
C
C
Müller
E
E
Ohmann
C
C
Schöffel
U
U
Lopez-Boado
M A
MA
Sganga
G
G
Stefani
A
A
Kronberger
L
L
D018806:APACHE; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015331:Cohort Studies; D004731:Endotoxins / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D018950:Lipopolysaccharide Receptors / Q000097:blood; D008954:Models, Biological; D009102:Multiple Organ Failure / Q000276:immunology*; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D011961:Receptors, Fc / Q000097:blood / Q000235:genetics
D000900:Anti-Bacterial Agents; D004731:Endotoxins; D015850:Interleukin-6; D016209:Interleukin-8; D018950:Lipopolysaccharide Receptors; D011961:Receptors, Fc