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Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock

Herz-Kreislauf-Parameter und Score-Systeme in der Beurteilung des Therapieerfolges bei Sepsis und septischem Schock

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Summary

In 47 medical and postoperative ICU patients with 57 episodes of sepsis and septic shock, cardiovascular parameters including systemic vascular resistance (SVR), cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI) as well as six scoring systems (APACHE II, Elebute, Goris, HIS, SAPS and SSS) were studied regarding their usefulness in the assessment of disease progression and evaluation of response to supplemental sepsis therapy (immunoglobulins, plasmapheresis). Among the hemodynamic parameters, only a prompt SVR improvement significantly discriminated between ultimate survivors and nonsurvivors. Thus, an increase in SVR (>160 dyn*cm−5*sec, within days 0 to 4, persisting for >24 hours) can serve as a prognostically validated “response” criterion (responders/non-responders: 26/31; mortality: 27% vs. 77%). Non-invasively, the APACHE II score was best suited (specificity: 88%, sensitivity: 67%) to classify hemodynamically defined responders to supplemental sepsis treatment (score-reduction ≥4 on day 4 after onset of therapy).

Zusammenfassung

Bei 47 internistischen sowie postoperativen Intensivpatienten mit insgesamt 57 Episoden von Sepsis und septischem Schock wurden Herz-Kreislauf-Parameter inklusive systemischer Gefäßwiderstand (SGW), Herzindex, Schlagvolumenindex und linksventrikulärer Schlagarbeitsindex sowie sechs Score-Systeme (APACHE II, Elebute, Goris, HIS, SAPS und SSS) in ihrer Wertigkeit zur Beurteilung des Krankheitsverlaufes sowie des Ansprechens auf additive Sepsistherapie (Immunglobuline, Plasmapherese) untersucht. Von den hämodynamischen Parametern diskriminierte nur der — prompt nachweisbare — Anstieg des SGW signifikant zwischen letztlich überlebenden und nicht überlebenden Patienten. Ein Anstieg des SGW (>160 dyn*cm−5*s innerhalb von vier Tagen, länger als 24 Stunden anhaltend) kann somit als prognostisch validiertes „Responder“-Kriterium dienen (Responder/Non-Responder: 26/31; Letalität: 27% vs. 77%). Nichtinvasiv erwies sich der APACHE II Score (Kriterium: Score-Abfall ≥4 bis zum Tag 4 nach Therapiebeginn) zur Klassifizierung der hämodynamisch definierten Therapie-„Responder“ bei additiver Sepsistherapie am besten geeignet (Spezifität: 88%, Sensitivität 67%).

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  1. Medizinische Klinik I, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, W-8000, München 70, Germany

    G. Pilz PD. &  K. Werdan

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Pilz, G., Werdan, K. Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock. Infection 18, 253–262 (1990). https://doi.org/10.1007/BF01646996

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