Year 2017 Vol. 25 No 5

ANESTESIOLOGY-REANIMATOLOGY

S.A. TACHYLA

PREDICTORS FOR THE DEVELOPMENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME IN PATIENTS AFTER ABDOMINAL SURGERY

ME «Mogilev Regional Hospital», Mogilev
The Republic of Belarus

Objectives. To determine the diagnostic value of clinical and laboratory findings in patients within the first 24 hours after the abdominal surgery as a predictive factor for prognosis of multiple organ dysfunction syndrome (MODS) development.
Methods. A prospective case-control study in patients (n=157) was carried out, which identified a number of clinical and laboratory findings within the first day after the abdominal surgery. Two groups were singled out: the first one (n=88) – without any symptoms of MODS, the second (n=69) – with the presence of MODS.
Results. It was revealed that the patients in the second group had a significant increase in heart rate variability (p=0.005), a reduction of mean arterial pressure (p=0.045), and oxygenation index (p=0.001). Diuresis in patients did not differ between the groups, but urea and creatinine levels were significantly increased in the second group (p<0.001). A reduction of total protein (p=0.007) and cholesterol (p=0.029) reflecting the change in metabolism was registered in the second group.
The analysis of the characteristic curves showed that SOFA scores (area under the curve [AUC]): 0.857; 95% confidence interval [CI]: 0.773-0.941; ð<0.001) and Apache III: (AUC 0.83; 95% CI 0.734-0.916; ð<0.001) seemed to have a better predictive value concerning MODS. A high predictive efficiency has been expressed in results of the comparative analysis: oxygenation index (AUC 0.717; 95% CI 0.621-0.813; ð=0.001) and cholesterol level (AUC 0.724; 95% CI 0.667-0.782; ð<0.001). Total protein level is an indicator of an average diagnostic efficacy (AUC 0.65; 95% CI 0.549-0.746; ð=002). Elevated C-reactive protein test has not been shown to be a marker for the development of MODS in the first 24 hours after the abdominal surgery.
Conclusion. The SOFA score is shown to have advantages in comparison with Apache III scale of MODS, because the total maximum SOFA score can be easily calculated. Patients after abdominal surgery on admission to the intensive care unit are needed to determine the value of oxygenation index. Due to the cheapness and technical simplicity of total cholesterol level it can be used as a screening of MODS.

Keywords: multiple organ dysfunction syndrome, predictors, oxygenation index, cholesterol, total protein, C-reactive protein, abdominal surgery
p. 494-502 of the original issue
References
  1. Kochetkov AV, Gudilov MS. Kliniko-laboratornaia diagnostika i monitoring gnoino-septicheskikh oslozhnenii posle operatsii na organakh briushnoi polosti [Clinical and laboratory diagnostics and monitoring of purulent-septic complications after operations on the abdominal organs]. Novosti Khirurgii. 2015;23(1):105-11. doi: 10.18484/2305-0047.2015.1.105.
  2. Karsanov AM, Remizov OV, Maskin SS, Kul'chiev AA, Karsanova ZO. Diagnostika sepsisa [Diagnosis of sepsis ]. Vestn khirurgii im II Grekova. 2016;(6):98-103.
  3. Savel'ev VS, Gel'fand BR, red. Sepsis: klassifikatsiia, kliniko-diagnosticheskaia kontseptsiia i lechenie [Sepsis: classification, clinical-diagnostic concept and treatment]: ruk. Moscow, RF: Med Inform Agentstvo; 2013. 360 p.
  4. Baily PM, Child CS. Endocrine response to surgery. In: Kaufman L, ed. Anaesthesia Review 4. Edinburgh, GB: Churchill Livingstone; 1987. ð. 100-16.
  5. Kraft TM, Apton PM. Kliuchevye voprosy i temy v anesteziologii [Key questions and topics in anesthesiology]: per s angl. Moscow, RF: Meditsina; 1997. 348 p.
  6. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003 Apr;29(4):530-38.
  7. Ostrovskii VK, Makarov SV, Iangolenko DV, Rodionov PN, Kochetkov LN, Asanov BM. Pokazateli krovi i leikotsitarnyi indeks intoksikatsii pri otsenke tiazhesti techeniia i opredelenii prognoza vospalitel'nykh, gnoinykh i gnoino-destruktivnykh zabolevanii organov briushnoi polosti i legkikh [Blood counts and leukocyte index of intoxication in assessing the severity of the course and determining the prognosis of inflammatory, suppurative and purulent-destructive diseases of the abdominal cavity and lungs]. Ul'ian Med-Biol Zhurn. 2011;(1):73-78.
  8. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992 Jun;101(6):1644-55.
  9. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. doi: 10.1001/jama.2016.0287.
  10. Gain IuM, Khulup GIa, Zavada NV, Alekseev SA, Bogdan VG. Ob"ektivnaia otsenka tiazhesti sostoianiia bol'nykh i prognoz v khirurgii [Objective assessment of the severity of patients and prognosis in surgery]. Minsk, RB: BelMAPO; 2005. 299 p.
  11. Sotnikov AV, Kurmukov IA. Prognosticheskoe znachenie shkal SAPS II i APACHE II u bol'nykh s sindromom poliorgannoi nedostatochnosti rannego posleoperatsionnogo perioda posle onkokhirurgicheskikh vmeshatel'stv [Prognostic value of the scales SAPS II and APACHE II in patients with the syndrome of multiple organ failure in the early postoperative period after oncosurgical interventions]. Anesteziologiia i Reanimatologiia. 2003;(2):37-39.
  12. Barbas CS, Isola AM, Caser EB. What is the future of acute respiratory distress syndrome after the Berlin definition? Curr Opin Crit Care. 2014 Feb;20(1):10-6. doi: 10.1097/MCC.0000000000000058.
  13. Cirstea M, Walley KR, Russell JA, Brunham LR, Genga KR, Boyd JH. Decreased high-density lipoprotein cholesterol level is an early prognostic marker for organ dysfunction and death in patients with suspected sepsis. J Crit Care. 2017 Apr;38:289-94. doi: 10.1016/j.jcrc.2016.11.041.
  14. Helliksson F, Wernerman J, Wiklund L, Rosell J, Karlsson M. The combined use of three widely available biochemical markers as predictor of organ failure in critically ill patients. Scand J Clin Lab Invest. 2016 Oct;76(6):479-85. doi: 10.1080/00365513.2016.1201850.
  15. Ho KM, Lee KY, Dobb GJ, Webb SA. C-reactive protein concentration as a predictor of in-hospital mortality after ICU discharge: a prospective cohort study. Intensive Care Med. 2008 Mar;34(3):481-87.
Address for correspondence:
212016, Republic of Belarus,
Mogilev, Belyinitskogo-Biruli str., 12,
ME «Mogilev Regional Hospital»,
Unit of Anesthesiology and Reanimation,
tel./fax: 375 222 50-08-81,
e-mail: tsa80@inbox.ru,
Sergey A. Tachyla
Information about the authors:
Tachyla S.A., PhD, Anesthetist-Resuscitator of ME «Mogilev Regional Hospital».
Contacts | ©Vitebsk State Medical University, 2007-2023