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Eur J Cardiothorac Surg 2000;17:30-37
© 2000 Elsevier Science NL

Improved outcome of APACHE II score-defined escalating systemic inflammatory response syndrome in patients post cardiac surgery in 1996 compared to 1988–1990: the ESSICS-study pilot project

^a Department of Medicine III, University of Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle, Germany
^b Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany
^c Zentralklinik Bad Berka GmbH, D-09437 Bad Berka, Germany
^d Department of Cardiac Surgery, University of Munich, Munich, Germany
^e Department of Medicine, University of Munich, Munich, Germany
^f Department of Cardiac Surgery, University of Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle, Germany

Corresponding author. Tel.: +49-345-557-4545; fax: +49-345-557-4546
e-mail: ursula.mueller-werdan{at}medizin.uni-halle.de

Objective: Cardiac surgery using extracorporeal circulation leads to the release of cytokines and subsequently to a systemic inflammatory response syndrome, which is thought to be a negative prognostic factor for patients’ outcome. A stratification for the risk of an escalating systemic inflammatory response syndrome had been achieved in a monocenter study carried out in 1988–1990, using APACHE II scoring on the morning of the 1st postoperative day. We now re-evaluated this concept prospectively in three independent centers. Methods: The APACHE II based risk stratification was put to test in three independent heart surgery centers in the period from June to December 1996. Nine hundred and forty-five patients after elective cardiac surgery (excluding heart transplantation) with the assistance of the cardiopulmonary bypass were prospectively monitored. Results: We found an increase in mortality with higher APACHE II score values determined on the 1st postoperative day. The mortality rose to nearly 50% with an APACHE II score of 28. Patients at high risk for the development of a systemic inflammatory response syndrome (APACHE II score 24) significantly differed from patients at lower risk (APACHE II score <19) in the duration of mechanical ventilation and extracorporeal circulation, age and New York Heart Association (NYHA) classification (P<0.05). Conclusion: The APACHE II score determined on the morning of the 1st postoperative day helps identifying the subgroup of patients with escalating systemic inflammatory response syndrome. Comparison with the data obtained in the years 1988–1990, suggests a better prognosis in the current trial for patients at high risk with a similar degree of escalating systemic inflammatory response syndrome.

Key Words: APACHE II score • Cardiopulmonary bypass • Escalating systemic inflammatory response syndrome • Outcome after cardiac surgery • Risk stratification

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