Sepsis score and acute-phase protein response as predictors of outcome in septic surgical patients
L. Dominioni, R. Dionigi, M. Zanello, R. Monico, R. Cremaschi, R. Dionigi, A. Ballabio, M. Massa, M. Comelli, P. Dal Ri and al. et
In a series of 135 patients with severe surgical infections, we determined
the sepsis score and the plasma level of the acute-phase proteins
alpha-1-acid glycoprotein, alpha 1-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 (alpha-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.
