CORRELATION BETWEEN ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION (APACHE)-II SCORE AND IMMUNOLOGICAL PARAMETERS IN CRITICALLY ILL PATIENTS WITH SEPSIS

A relationship between physiological parameters of severe sepsis and i mmunological function has not been established. In ten severely ill pa tients with sepsis physiological risk was assessed by the Acute Physio logy and Chronic Health Evaluation (APACHE) III score, while one compo nent of immunological function was evaluated using peripheral blood mo nonuclear cell (PBMC) cytokine production after stimulation with lipop olysaccharide (LPS) in vitro. Five of the ten patients died. Mean(s.e. m.) APACHE III scores at admission were not significantly different be tween survivors and non-survivors (82(13) versus 95(13)) but after 72 h they were lower in survivors (51(13) versus 111(15), P<0.05). Downre gulation of cytokine production by PBMC on LPS stimulation was a trans ient event in survivors. Survivors had a three-fold increase in tumour necrosis factor alpha bioactivity within 72 h, but there was no incre ase in non-survivors. A similar pattern was demonstrated for interleuk in (IL) 1 beta (P < 0.05 between survivors and non-survivors) and IL-6 (P=0.06) immunoactivity, Physiological as well as immunological param eters in critically ill patients with sepsis independently predicted h ospital survival (r(2)=0.2). These data demonstrate a relationship bet ween the pattern of cytokine production in vitro and survival.