February 1987

Sepsis Score and Acute-Phase Protein Response as Predictors of Outcome in Septic Surgical Patients

Author Affiliations

From the Departments of Surgery (Drs Dominioni, Renzo Dionigi, Monico, and Ballabio), Pediatrics (Ms Massa), and Biostatistics (Mr Comelli), University of Pavia; Institute of Anesthesiology, University of Bologna (Dr Zanello); Intensive Care Service I (Dr Cremaschi) and II (Dr Roberto Dionigi), Policlinico S. Matteo, Pavia; Istituti Ospedalieri, Trento (Dr Dal Ri); and Fondazione Clinica del Lavoro, Pavia (Mr Pisati), Italy.

Arch Surg. 1987;122(2):141-146. doi:10.1001/archsurg.1987.01400140023001

• In a series of 135 patients with severe surgical infections, we determined the sepsis score and the plasma level of the acute-phase proteins α-1-acid glycoprotein, α1-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 (α-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.

(Arch Surg 1987;122:141-146)