[Experiences with various scores in evaluating the prognosis of postoperative intensive care patients]

At the intensive care unit of the Clinic for General and Abdominal Surgery and the Clinic for Emergency Medicine in Mainz, various scores (APACHE II score, HIS, TISS, ASA score), laboratory parameters (serum creatinine, white blood count, platelet count, serum lactate, serum elastase, Quick), body temperature, age as well as presence of a malignant underlying or associated disease, were analyzed with regard to their prognostic significance in 169 postoperative admissions. Apart from univariate analysis (Wilcoxon test) and a multivariate analysis (stepwise logistic regression), the value of the scores is demonstrated on the basis of sensitivity, specificity and correctness, as well as the behaviour of the scores at certain decisive points (cut-off point). Of the parameters studied, the APACHE II score, the HISS, the TISS and serum lactate had a significant influence on the outcome of intensive care. Examination of these scores and serum lactate at different decisive points (false-positive rate of 0%, point of highest sensitivity, point of maximal correctness) showed the TISS to have the best results. The TISS has, with a sensitivity of 100%, a false-positive rate of 41%, compared with 55% for the HIS, 81% for the APACHE II and 82% for serum lactate. With a false-positive rate of 0%, the sensitivity of the TISS is only 10%, of APACHE II and serum lactate 5% and of the HIS 0%. The patient with the highest HIS score has survived. The serum lactate level is another good parameter that is a lot easier to determine and is comparable to the APACHE II score and the HIS in its prognostic significance. Thus, scores are suitable for the estimation of the prognosis in certain patient groups. However, insufficient discrimination between patients who die and patients who survive means that these parameters cannot be used for individual therapeutic decisions in severely ill patients. The decision between the institution or cessation of intensive care is made by the physician or the medical team. Due to the use of prognostic factors, such as scores, decision-making can be objectified and therefore made easier.