Scoring-Systeme in der Diagnostik und Verlaufsbeurteilung der Sepsis—diagnostische und therapeutische Implikationen

摘要

To apply specific organ dysfunction scoring systems to patients with severe sepsis or septic shock is of paramount importance for both the stratification of the underlying severity of illness and the evaluation and follow-up of the therapeutic course. There is a clear association of number and progress of organ dysfunctions or failures and adverse outcomes in these patients. Presence of at least one organ failure is mandatory for diagnosing severe sepsis, or, if the cardiovascular system fails, septic shock. In Europe, severe sepsis with at least two organ failures or septic shock are indicative for adjunctive therapeutic approaches utilizing activated protein c (Xigris®). The structured assessment of organ failures in these patients is thus of therapeutic importance. The traditional severity of illness as well as therapeutic-interventional scoring systems may facilitate patient characterization for research purposes, aid continuous quality improvement initiatives, and support resource and staff utilization in the intensive care unit. Risk stratification of patients with severe sepsis or septic shock should be undertaken utilizing APACHE II, because a score exceeding 24 points would be indicative for adjunctive therapy with Xigris®.