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

Objective: Cardiac surgery using extracorporeal circulation leads to the re lease of cytokines and subsequently to a systemic inflammatory response syn drome, which is thought to be a negative prognostic factor for patients' ou tcome. A stratification for the risk of an escalating systemic inflammatory response syndrome had been achieved in a monocenter study carried out in 1 988-1990, using APACHE II scoring on the morning of the Ist postoperative d ay. We now re-evaluated this concept prospectively in three independent cen ters. Methods: The APACHE II based risk stratification was put to test in t hree 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 mort ality with higher ABACHE II score values determined on the ist postoperativ e day. The mortality rose to nearly 50% with an APACHE II score of greater than or equal to 28. Patients at high risk for the development of a systemi c inflammatory response syndrome (APACHE II score greater than or equal to 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). Concl usion: The APACHE II score determined on the morning of the Ist postoperati ve day helps identifying the subgroup of patients with escalating systemic inflammatory response syndrome. Comparison with the data obtained in the ye ars 1988-1990, suggests a better prognosis in the current trial for patient s at high risk with a similar degree of escalating systemic inflammatory re sponse syndrome. (C) 2000 Elsevier Science B.V. All rights reserved.