Скрининговые критерии полиорганной недостаточности после абдоминальных операций (клиническое исследование)

Objective: to determine the feasibility of using C-reactive protein (CRP) and cholesterol levels as biochemical screening markers for multiple organ dysfunction syndrome (MODS) in patients after abdominal surgery.Materials and methods. A prospective case-control study was performed in 192 patients who receivedtreatment at the Intensive Care Unit (ICU) after abdominal surgery. Patients were classified into two groups: Group 1 (n=95) of patients without MODS and Group 2 (n=97) of patients with MODS. The signs of MODS were identified based on 2001 SCCM/ACCP consensus conference criteria. During the first three post-operative days, total cholesterol and CRP levels were measured, and severity was assessed using prognostic scoring systems (SOFA and Apache III). Logistic regression analysis was used to evaluate five MODS prediction models based on total cholesterol levels, CRP levels, a combination of cholesterol and CRP levels as well as SOFA and Apache III scores.Results. Cholesterol levels in Group 2 were found to be significantly lower than those in Group 1 (3.13 (2.6–3.74) mmol/l vs 4.09 (3.26–5.01) mmol/l; P0.05). Significantly increased CRP levels in Group 2 compared to Group 1 were found (168.7 (90.2–247.2) mg/l vs 85.9 (35.6–172.6) mg/l; P0.05). AUC, sensitivity, and specificity values were determined for the study models and scales based on total cholesterol levels (AUC 0.679; 95% confidence interval (CI) 0.625–0.732), CRP levels (AUC 0.67; 95% CI 0.6–0.74), a combination of cholesterol and CRP levels (AUC 0.819; 95% CI 0.721–0.917), SOFA score (AUC 0.786; 95% CI 0.744–0.829), and Apache III score (AUC 0.631; 95% CI 0.582–0.68). The optimal threshold was 3.4 mmol/l and 96.5 mg/l for cholesterol and CRP levels, respectively.Conclusion. Total cholesterol and CRP monitoring revealed them as screening biomarkers informative for predicting MODS within the first three days after abdominal surgery. Using all these models, the probability of MODS development in a patient can be calculated as a function of the numerical value of the biomarker.Цель исследования: определение возможности применения С-реактивного белка (СРБ) и холестерина, как скрининговых биохимических маркеров развития синдрома полиорганной недостаточности (СПОН) у пациентов после абдоминальных хирургических вмешательств.Материалы и методы. Провели проспективное исследование (случай-контроль) у 192 пациентов,находившихся на лечении в отделении анестезиологии и реанимации после абдоминальных хирургических вмешательств. Пациенов разделили на 2 группы: 1-я группа (n=95) — пациенты без СПОН, 2-я группа (n=97) — пациенты с наличием СПОН. Определение признаков СПОН проводили на основании критериев, установленных согласительной конференцией SCCM/ESICM в 2001 г. В первые 3-е суток после операции определяли содержание общего холестерина и СРБ, тяжесть состояния пациентов по прогностическим шкалам SOFA и Apache III. Методом логистического регрессионного анализа оценили 5 моделей прогнозирования СПОН с использованием показателей содержания общего холестерина, СРБ, холестерина и СРБ одновременно, а также шкал SOFA и Apache III.Результаты. Выявили, что уровень холестерина во 2-й группе статистически значимо ниже, чем в 1-й группе — 3,13 (2,6–3,74) против 4,09 (3,26–5,01) ммоль/л (p0,05). Отметили статистически значимое увеличение содержания СРБ во 2-й группе по сравнению с 1-й группой — 168,7 (90,2–247,2) против 85,9 (35,6–172,6) мг/л (p0,05). Установили значения площадей AUC, чувствительности и специфичности исследуемых моделей и шкал: с использованием показателей содержания общего холестерина — AUC 0,679; 95% доверительный интервал (ДИ) 0,625–0,732; СРБ — AUC 0,67; 95% ДИ 0,6–0,74; холестерина и СРБ одновременно — AUC 0,819; 95% ДИ 0,721–0,917; SOFA — AUC 0,786; 95% ДИ 0,744–0,829 и Apache III — AUC 0,631; 95% ДИ 0,582–0,68. Оптимальный порог составил для холестерина — 3,4 ммоль/л, для СРБ — 96,5 мг/л.Заключение. Контроль содержания общего холестерина и СРБ, позволяет использовать их как скрининг для прогнозирования развития СПОН в первые 3-е суток после абдоминальных хирургических вмешательств. С помощью всех указанных моделей может быть рассчитана вероятность развития СПОН у пациента в зависимости от численного значения фактора

Screening Criteria for Multiple Organ Dysfunction after Abdominal Surgery (Clinical Research)

Objective: to determine the feasibility of using C-reactive protein (CRP) and cholesterol levels as biochemical screening markers for multiple organ dysfunction syndrome (MODS) in patients after abdominal surgery.Materials and methods. A prospective case-control study was performed in 192 patients who receivedtreatment at the Intensive Care Unit (ICU) after abdominal surgery. Patients were classified into two groups: Group 1 (n=95) of patients without MODS and Group 2 (n=97) of patients with MODS. The signs of MODS were identified based on 2001 SCCM/ACCP consensus conference criteria. During the first three post-operative days, total cholesterol and CRP levels were measured, and severity was assessed using prognostic scoring systems (SOFA and Apache III). Logistic regression analysis was used to evaluate five MODS prediction models based on total cholesterol levels, CRP levels, a combination of cholesterol and CRP levels as well as SOFA and Apache III scores.Results. Cholesterol levels in Group 2 were found to be significantly lower than those in Group 1 (3.13 (2.6–3.74) mmol/l vs 4.09 (3.26–5.01) mmol/l; P0.05). Significantly increased CRP levels in Group 2 compared to Group 1 were found (168.7 (90.2–247.2) mg/l vs 85.9 (35.6–172.6) mg/l; P0.05). AUC, sensitivity, and specificity values were determined for the study models and scales based on total cholesterol levels (AUC 0.679; 95% confidence interval (CI) 0.625–0.732), CRP levels (AUC 0.67; 95% CI 0.6–0.74), a combination of cholesterol and CRP levels (AUC 0.819; 95% CI 0.721–0.917), SOFA score (AUC 0.786; 95% CI 0.744–0.829), and Apache III score (AUC 0.631; 95% CI 0.582–0.68). The optimal threshold was 3.4 mmol/l and 96.5 mg/l for cholesterol and CRP levels, respectively.Conclusion. Total cholesterol and CRP monitoring revealed them as screening biomarkers informative for predicting MODS within the first three days after abdominal surgery. Using all these models, the probability of MODS development in a patient can be calculated as a function of the numerical value of the biomarker