SEPSIS SIRS, PHYSIOLOGICAL - CLASSIFICATION, SEVERITY STRATIFICATION,RELATION TO CYTOKINE ELABORATION AND OUTCOME PREDICTION IN POSTTRAUMACRITICAL ILLNESS/

Objective: To develop a quantitative severity stratification within th e framework of a Physiologic State Classification (PSSC) system that c an he applied to critically ill posttrauma patients with ''sepsis/SIRS '' and to relate PSSC to the nature of the plasma cytokine response. M aterials and Methods: At each study time period, a patient was classif ied into one of seven physiologic States previously derived from clust ering 17 cardiopulmonary and metabolic variables from 338 critically i ll patients: R = reference, A = normal stress response, B = metabolic insufficiency, C-1 (early) and C-2 (late) = respiratory insufficiency, D = cardiogenic insufficiency, H = nonshock hypovolemia. Main Results : The PSSC used State data from a developmental set of 159 trauma pati ents in a logistic model (L2PDEATH) to provide a quantitative index of severity, This severity index was tested on 80 new trauma patients (m ean Injury Severity Score (ISS) = 27.6, 64% survivors), Using PSSC Sta te distributions for evaluation of enzyme-linked immunosorbent assay ( ELISA) measured cytokines interleukin (IL)-1, IL-6, IL-8, tumor necros is factor (TNF) showed the multicytokine score to be greatest in those C-2- and B-State regions associated with a higher severity as measure d by L2PDEATH, Compared with ARDEATH of the Acute Physiology and Chron ic Health Evaluation (APACHE) II scoring system, L2PDEATH provided a b etter indicator of severity of sepsis/systemic inflammatory response s yndrome (SIRS) for posttrauma patients, Conclusion: PSSC allows classi fication of the physiologic and cytokine mediator response to trauma a nd permits stratification of severity in posttrauma critical illness.