Correlation between acute physiology and chronic health evaluation (APACHE) III score and immunological parameters in critically ill patients with sepsis
✍ Scribed by M. A. Rogy; H. S. A. Oldenburg; S. Coyle; R. Trousdale; L. L. Moldawer; Dr S. F. Lowry
- Publisher
- John Wiley and Sons
- Year
- 1996
- Tongue
- English
- Weight
- 599 KB
- Volume
- 83
- Category
- Article
- ISSN
- 0007-1323
No coin nor oath required. For personal study only.
✦ Synopsis
A relationship between physiological parameters of severe sepsis and immunological function has not been established. In ten severely ill patients with sepsis physiological risk was assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) 111 score, while one component of immunological function was evaluated using peripheral blood mononuclear cell (PBMC) cytokine production after stimulation with lipopolysaccharide (LPS) in vitro. Five of the ten patients died. Mean(s.e.m.) APACHE 111 scores at admission were not significantly different between survivors and non-survivors (82(13) versus 95(13)) but after 72 h they were lower in survivors (51(13) versus 111(15), P<O.O5). Downregulation of cytokine production by PBMC on LPS stimulation was a transient event in survivors. Survivors had a three-fold increase in tumour necrosis factor Q bioactivity within 72 h, but there was no increase in non-survivors. A similar pattern was demonstrated for interleukin (IL) 1p (P < 0.05 between survivors and non-survivors) and IL-6 (P = 0.06) immunoactivity. Physiological as well as immunological parameters in critically ill patients with sepsis independently predicted hospital survival (Tz = 0.2). These data demonstrate a relationship between the pattern of cytokine production in vitro and survival. Clinical assessment of patients in a surgical intensive care unit (ICU) relies on methods that discriminate between severity of illness and clinical outcome. Research has focused on quantifying disease severity as well as estimating prognosis and outcome'-'. Several indices have been developed which predict mortality of adult patients admitted to ICUsi-'. The Acute Physiology and Chronic Health Evaluation (APACHE) I1 score developed by Knaus et aL8 is the most widely tested and validated"'.
Recently, Knaus et ~1 . ' ~ presented a revised and improved form of APACHE 11, termed the APACHE Ill prognostic system. This system may reduce uncertainty about difficult clinical decisions and may be used by physicians to direct health care towards more scientific and ethical approaches". The new prognostic system has two components, the APACHE I11 score and the APACHE 111 predictive equation. The latter uses the APACHE 111 score and reference data on major disease categories and treatment location immediately before admission to the ICU.
Physiological parameters included in the APACHE Ill score are, at least in part, regulated by the production of proinflammatory cytokines. Some studies have demonstrated a correlation between outcome and raised cytokine levels in the circulation'"'8. Research has also focused on in vitro cytokine production by cells or cell systems as prediction modalities'"-2'. The ability of peripheral blood mononuclear cells (PBMC) to produce cytokines following stimulation with lipopolysaccharide (LPS) has been investigated most commonly.
In the present study mononuclear cell function in patients with sepsis in the surgical ICU was investigated. In vitro cytokine production by PWMC was evaluated over 72 h following admission to the ICU and was compared