SERUM PHOSPHOLIPASE-A2 IN PATIENTS WITH MULTIPLE ORGAN FAILURE

Multiple organ failure (MOF) is the most common cause of death in the surgical intensive care unit. We studied the relation of MOF to change s in the concentration of group II phospholipase A2 (PLA2) in serum. A ltogether, 215 surgical intensive care patients with multiple injuries , diffuse peritonitis, or sepsis and control patients, who were at a h igh risk for postoperative sepsis after various surgical interventions , were included in the present prospective study. The clinical perform ance of the MOF score and the concentrations of group II PLA2 and C-re active protein (CRP) in serum were studied using receiver operating ch aracteristic (ROC) curves. The group II PLA2 level was considerably ab ove normal in all groups of patients during the first week of observat ion. There was a highly significant difference in group II PLA2 levels between patients with severe infections (peritonitis and sepsis) and the other patients studied (multiple injuries and elective surgery) (R OC 0.931, P < 0.0001). The concentration of group II PLA2 had a signif icant positive correlation to the CRP level and body temperature, whic h indicates that group II PLA2 is an acute phase reactant and that the determination of group II PLA2 is a useful measurement to diagnose se vere infections. It was concluded that the concentration of group II P LA2 in serum effectively predicts lethal MOF in patients with multiple injuries after the second day (ROC 0.739, P < 0.01) and in patients w ith diffuse peritonitis after the fourth day (ROC 0.750, P < 0.02). (C ) 1996 Academic Press, Inc.