[Early detection of patients at risk for infection after heart surgery]

Since sepsis is a major cause of mortality after cardiac surgery, early identification of the patients at risk of developing septic complications is of considerable importance. In the present study on 110 patients after elective heart surgery, we, therefore, examined scoring systems as well as various single parameters with regard to an early prediction of septic complications. In a first step, the Elebute score definition for postoperative sepsis in general surgery patients (score > or = 12) could be confirmed for cardiac surgery patients as well. Septic complications, defined as an Elebute score > or = 12 on > or = 2 days, occurred in 16 patients and were associated with a significantly worse prognosis than in non-septic patients (mortality 69 vs. 1%). Consequently, other more practicable parameters were investigated: five additional scores (APACHE II, Goris, HIS, SAPS, SSS) were comparable and superior to plasma levels of elastase and neopterin, haemodynamic data, and clinical parameters in predicting septic complications as early as by the 1st postoperative day. For reasons of practicability and availability, the APACHE II score (predictive values: positive 86%, negative 96%, Youden index 0.73; diagnostic cut off point: > or = 19 on the 1st postoperative day) seemed to be best suited. Therefore, this was further investigated within a consecutive prospective study (independent group of 106 patients) which confirmed an APACHE II score > or = 19 as discriminating criterion (mortality 36 vs 0%). Thus, the APACHE II score may be useful for prospective screening, with the intention to treat, of patients after cardiac surgery who are at risk of postoperative septic complications.