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Evaluation of definitions and parameters for sepsis assessment in patients after cardiac surgery

Wertigkeit von Sepsisdefinitionen und-parametern bei Patienten nach Herzchirurgie

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Summary

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 ≥ 12) could be confirmed in an extended form (≥ 12 on ≥ 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 ≥ 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.

Zusammenfassung

Bei 110 Patienten nach elektiven herzchirurgischen Eingriffen unter Zuhilfenahme der extrakorporalen Zirkulation wurde die Wertigkeit verschiedener Parameter zur frühzeitigen Beurteilung septischer Komplikationen untersucht. In einem ersten Schritt konnte die Elebute Score-Definition für postoperative Sepsis nach Allgemeinchirurgie (Score ≥ 12) bei herzchirurgischen Patienten in einer erweiterten Form (≥ 12 an ≥ 2 Tagen) bestätigt werden. Anhand dieser Definition (Gültigkeit für die klinisch definierte Sepsis-assoziierte Letalität: 94%) traten bei 16 Patienten septische Komplikationen auf, welche mit einer signifikant schlechteren Prognose im Vergleich zu nichtseptischen Patienten einhergingen (Letalität 69% vs. 1%, p<0,0001). Im Gegensatz hierzu wies SIRS (bestes Klassifikationskriterium: positiv an ≥ 3 Tagen) eine niedrigere Spezifität für die klinisch definierte Sepsis-assoziierte Letalität auf, zumindest im frühen postoperativen Verlauf (Gültigkeit: 67%). Basierend auf der Elebute Score-Klassifizierung wurden weitere, praktikablere Parameter im Hinblick auf ihre Wertigkeit zur frühzeitigen Sepsisrisikobeurteilung nach Herzchirurgie untersucht. Fünf weitere Schweregrad-Scores (APACHE II, MOF-Goris, HIS, SAPS, SSS) erwiesen sich als untereinander vergleichbar (ROC-Flächen: 0,94 bis 0,96) und anderen Meßgrößen (Plasma-Elastase und -Neopterin, hämodynamische Daten, klinische Routineparameter) überlegen im Hinblick auf die frühzeitige Vorhersage (erster postoperativer Tag) des Risikos septischer Komplikationen.

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  1. Medizinische Klinik I, Klinikum Großhadern der Universität München, Marchioninistraße 15, D-81377, München, Germany

    G. Pilz,  S. Kääb &  K. Werdan

  2. Herzchirurgische Klinik, Klinikum Großhadern der Universität München, Marchioninistraße 15, D-81377, München, Germany

    E. Kreuzer

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Pilz, G., Kääb, S., Werdan, K. et al. Evaluation of definitions and parameters for sepsis assessment in patients after cardiac surgery. Infection 22, 8–17 (1994). https://doi.org/10.1007/BF01780757

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