Estimating mortality risk in preoperative patients using immunologic, nutritional, and acute-phase response variables

Area of Science:

• Immunology
• Surgical Oncology
• Critical Care Medicine

Background:

• Assessing preoperative host immunocompetence is crucial for predicting surgical outcomes.
• Septic-related deaths pose a significant risk in the postoperative period.
• Identifying reliable biomarkers for mortality risk is essential for patient management.

Observation:

• Delayed type hypersensitivity (DTH) skin test response, age, serum albumin, hemoglobin, and total hemolytic complement levels differed significantly between patients who survived and those who died from sepsis.
• Logistic regression identified DTH skin test response and serum albumin as independent predictors of septic-related mortality.
• A validated predictive model incorporating DTH and serum albumin demonstrated good predictive capability in a separate patient cohort.

Findings:

• Reduced DTH skin test response (anergy) and low serum albumin were significantly associated with increased septic-related deaths in elective surgical patients.
• The study identified a predictive equation for mortality risk with strong statistical validation.
• The area under the Receiver-Operating-Characteristic (ROC) curve (Az = 0.79) indicates good discriminatory power of the predictive model.

Implications:

• Preoperative assessment of immune function (DTH) and nutritional status (serum albumin) can help identify high-risk surgical patients.
• Early intervention strategies targeting immune deficits and nutritional support may reduce septic-related mortality.
• These findings support the integration of immunological and nutritional markers into routine preoperative risk stratification protocols.