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

Early Sepsis Treatment With Immunoglobulins After Cardiac Surgery in Score-identified High-risk Patients - MethodsIn patients after cardiac surgery, the incidence of infections is high, due to cardiac impairment and the intraoperative use of extracoqioreal circulation and its sequelae. Accordingly, sepsis and septic multiple organ failure are among the major causes of death.
Using the APACHE II scores for assessment of disease severity, we have shown that failure to improve promptly after heart surgery (criterion: score 19 on the first postoperative day) was highly predictive for septic complications, associated with a significantly higher mortality. On the other hand, a treatment-associated fall within a 4-day period in APACHE II scores in patients with sepsis has been demonstrated to lead to reduction in mortality by more than 50 percent. Using this score in the present study, we (1) prospectively identified postoperative cardiac surgical patients at risk and (2) investigated whether early supplemental sepsis treatment led to an improvement in disease severity and outcome, compared with a matching historical control population. As supplemental sepsis treatment, we used intravenous (IV) immunoglobulin (Ig), which has been shown to reduce infections after cardiac surgery when given prophy-lactically. canadian neighbor pharmacy

Study Population and Treatment Regimen
The control group consisted of all patients after elective open-heart surgery (excluding transplantation) at the Department of Cardiac Surgery, Grosshadem Hospital, University of Munich, who during the period December 1988 to March 1989 and April 1990 to November 1990 had an APACHE II score of 19 on the morning of the first postoperative dav (“day 1 ”). Part of this population had served to establish the sepsis risk score prediction criterion (Fig 1a). From December 1990 to June 1992, all patients fulfilling these criteria received an Ig preparation in an open (nonblinded) manner. From December 1990 to October 1991, IV IgG (Psomaglobin N, Tropon Biologische Priiparate, Cologne, Germany, dosage: day 1: 8 ml/kg; day 2: 4 ml/kg) was used as standard Ig therapy regimen; from November 1991 to June 1992, IV IgGMA (Pentaglobin, Biotest, Dreieich, Germany, dosage: 5 ml/kg on days 1, 2, and 3) was given. There was no restriction regarding standard therapy. All patients had given informed consent. The protocol of this study was approved by the University of Munich Medical Faculty Ethics Committee.


Figure 1. Early postoperative risk stratification for the development of septic complications after cardiac surgery. Left (a): Control patients’ stratification based on the APACHE II scores on the first postoperative day (day 1 ).7 Right (h): Influence of Igtreatment on APACHE II score in high-risk patients (baseline APACHE II score > 24). For further details, see text.

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