SCORING SYSTEMS AND BLOOD LACTATE CONCENTRATIONS IN RELATION TO THE DEVELOPMENT OF ADULT-RESPIRATORY-DISTRESS-SYNDROME AND MULTIPLE ORGAN FAILURE IN SEVERELY TRAUMATIZED PATIENTS

In 56 patients with multiple trauma with ISSs greater-than-or-equal-to 33 we prospectively collected data of seven scoring systems (ISS, TS, TRISS, GCS, PTS, APACHE II, SSS) and sequentially determined blood la ctate concentrations. These data were analyzed in relation to the pati ents later developing adult respiratory distress syndrome (ARDS) and m ultiple organ failure (MOF). Twenty-two patients developed ARDS, and 1 8 developed MOF. Of the mentioned scoring systems only ISS, PTS, and S SS were predictive of subsequent ARDS, and only ISS and SSS were predi ctive of subsequent MOF. Lactate concentrations at days 2, 3, and 4 we re significantly different between patients with and without subsequen t ARDS, MOF, or both. Surprisingly, APACHE II scores did not correlate with subsequent ARDS or MOF, nor did they show any significant relati on with lactate concentrations at any time. By stepwise regression ana lysis ISS, SSS, and lactate level at day 3 were the most significant v ariables toward the development of ARDS and MOF. It is concluded that scoring systems directly grading the severity of groups of trauma pati ents have predictive value for late and remote complications such as A RDS and MOF, whereas scoring systems that grade the physiologic respon se to trauma-although clearly related to mortality-have no such predic tive value.