Early Sepsis Treatment With Immunoglobulins After Cardiac Surgery in Score-identified High-risk Patients – Discussion

Identification of Risk Patients
A major problem of postoperative care is the early identification of patients at risk of developing sepsis and multiple organ failure. By comparing different parameters on the first postoperative day in patients after cardiac surgery (plasma elastase and neopterin, hemodynamic data, scoring systems), we have found the best predictive value for several scoring systems (work in preparation). Among these, the APACHE II score was selected for its best practicability (routine bedside availability within 5 to 10 min using a microcomputer-based program). It is applicable for imminent sepsis risk stratification, discriminating on the first postoperative day between the large population of low-risk patients (score < 19) with mostly uneventful course and the small groups of patients at risk (19 to 23) and high risk ( < 24) who have an at least tenfold higher postsurgical mortality (Fig la). This approach yields several advantages: (1) early and standardized use of supplemental treatment; (2) specific use of therapy in the small percentage of risk patients (Table 1) and thus cost-effectiveness; (3) early physicians’ awareness of a patient’s risk (leading, for instance, to increased antibiotic therapy [Table 1]); and (4) clear-cut prospective identification of the target treatment groups, avoiding the problem of treating a large population although therapy is likely to be efficacious only in a minority who are not a priori identifiable (note recent controversy; over monoclonal endotoxin antibodies in sepsis with Gram-negative bacteremia). buy claritin online

The results of this clinical trial show that early supplemental sepsis treatment with either IgG or IgGMA significantly improves disease severity in high-risk patients after cardiac surgery, the limitation of a historical group taken into account. Furthermore, this improvement leads to a reduction in hospital mortality (Fig 2), although this was of statistical significance only for the exploratory analysis for Ig treatment as a whole. Our observations add to the growing evidence that Ig treatment can reduce sepsis mortality in selected subsets of patients.

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