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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)

Elebute EA, Stoner HB:  The grading of sepsis . Br J Surg 1983;70: 29-31.Article
Stevens LE:  Gauging the severity of surgical sepsis . Arch Surg 1983;118:1190-1192.Article
Dionigi R, Dominioni L, Jemos V, et al:  Sepsis score and complement factor B for monitoring severely septic surgical patients and for predicting their survival . Eur Surg Res 1985;17:269-280.Article
Schutte M, DiCamelli R, Murphy P, et al:  C3 proactivator (C3PA) as an acute phase reactant . Clin Exp Immunol 1974;18:251-256.
Dominioni L, Dionigi R, Campani M:  Postoperative infections and variations of complement components in cancer patients . Tumori 1980;66: 583-593.
Fearon DT, Ruddy S, Schur PH, et al:  Activation of the properdin pathway of complement in patients with gram-negative bacteremia . N Engl J Med 1975;292:937-940.Article
Moyer E, Cerra F, Chenier R, et al:  Multiple systems organ failure: VI. Death predictors in the trauma-septic state: The most critical determinants . J Trauma 1981;21:862-869.Article
Cullen DJ, Civetta JM, Briggs BA, et al:  Therapeutic intervention scoring system: A method for quantitative comparison of patient care . Crit Care Med 1974;2:57-60.Article
Baue AE, Günther B, Hartl W, et al:  Altered hormonal activity in severely ill patients after injury or sepsis . Arch Surg 1984;119:1125-1132.Article
Knaus WA, Zimmerman JE, Wagner DP, et al: APACHE:  Acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;9:591-597.Article
Pine RW, Wertz MJ, Lennard ES, et al:  Determinants of organ malfunction or death in patients with intra-abdominal sepsis . Arch Surg 1983;118:242-249.Article
Dominioni L, Dionigi P, Pisati P, et al:  Acute-phase protein response and complement activation in patients with peritonitis: Relationships with survival . Eur Surg Res 1986;1( (suppl) ):16.
Owen JA:  Effect of injury on plasma proteins . Adv Clin Chem 1967;9:1-41.
Koj A:  Acute-phase reactants , in Allison A (ed): Structure and Function of Plasma Proteins . New York, Plenum Publishing Corp, 1974.
Dominioni L, Dionigi R, Jemos V:  The acute-phase response of plasma proteins in surgical patients , in Wesdorp RIC, Soeters PB (eds): Clinical Nutrition '81 . New York, Churchill Livingstone Inc, 1982.
Sganga G, Siegel JH, Brown G, et al:  Reprioritization of hepatic plasma protein release in trauma and sepsis . Arch Surg 1985;120:187-199.Article
Ganz PA, Shell WE, Tökés ZA:  Evaluation of a radioimmunoassay for alpha-1-acid glycoprotein to monitor therapy of cancer patients . JNCI 1983;71:25-30.
Costello MJ, Gewurz H, Siegel JN:  Inhibition of neutrophil activation by alpha-1-acid glycoprotein . Clin Exp Immunol 1984;55:465-472.
Wilson GB, Walker IH Jr, Watkins JH Jr, et al:  Determination of subpopulations of leukocytes involved in the synthesis of alpha-1-antitrypsin in vitro . Proc Soc Exp Biol Med 1980;164:105-114.Article
Ohlsson K:  Alpha-1-antitrypsin and alpha-2-macroglobulin interactions with human neutrophil collagenase and elastase . Ann NY Acad Sci 1975;256:409-419.Article
Fearon DT, Austen KF:  The alternative pathway of complement: A system for host resistance to microbial infection . N Engl J Med 1980;303: 259-263.Article
Le Gall JR, Loirat P, Alperovitch A, et al:  A simplified acute physiology score for ICU patients . Crit Care Med 1984;12:975-977.Article
Baker SP, O'Neill B, Haddon W, et al:  The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care . J Trauma 1974;143:187-192.Article
Dionigi R, Cremaschi RE, Jemos V, et al:  Nutritional assessment and severity of illness classification systems: A critical review on their clinical relevance . World J Surg 1986;10:2-11.Article
Synder JV, McGuirk M, Grenvik A, et al:  Outcome of intensive care: An application of a predictive model . Crit Care Med 1981;9:598-603.Article