Objective: Currently most nutritional assessment techniques are based on their ability to predict clinical outcomes. However, the validity of any of these techniques to truly measure “nutritional risk” has not been proved. We have therefore prospectively assessed the prognostic value of two nutritional assessment techniques and nonnutritional factors in determining outcome after major abdominal surgery. Methods: At admission and discharge, 100 patients undergoing major abdominal surgery were assessed on the following items: Subjective Global Assessment, Nutritional Risk Index, anthropometric measurements, serum total protein, serum albumin, lymphocyte count, total serum cholesterol. Patients were monitored for postoperative complications until death or discharge. Results: At admission, 44% of the patients were malnourished according to the Subjective Global Assessment, while 61% of the patients were malnourished according to the Nutritional Risk Index. At discharge, these numbers were 67% and 82%, respectively. Higher death rates were found in the malnourished groups. The risk of complication was increased in malnourished patients with both assessment techniques. The odds ratios for the association between malnutrition and complications varied between 1.926 and 9.854 with both assessments. The presence of cancer in the patient was predictive for complication. Conclusions: Malnutrition is a marker of bad outcomes. Both Subjective Global Assessment and Nutritional Risk Index nutrition tests are predictive for malnutrition and postoperative complications in patients undergoing major abdominal surgery.

Introduction: The diagnosis of sepsis in critically ill patients is challenging because traditional markers of infection are often misleading. The present study was conducted to determine the procalcitonin level at early diagnosis (and differentiation) in patients with systemic inflammatory response syndrome (SIRS) and sepsis, in comparison with C-reactive protein, IL-2, IL-6, IL-8 and tumour necrosis factor-α. Method: Thirty-three intensive care unit patients were diagnosed with SIRS, sepsis or septic shock, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria. Blood samples were taken at the first and second day of hospitalization, and on the day of discharge or on the day of death. For multiple group comparisons one-way analysis of variance was applied, with post hoc comparison. Sensitivity, specificity and predictive values of PCT and each cytokine studied were calculated. Results: PCT, IL-2 and IL-8 levels increased in parallel with the severity of the clinical condition of the patient. PCT exhibited a greatest sensitivity (85%) and specificity (91%) in differentiating patients with SIRS from those with sepsis. With respect to positive and negative predictive values, PCT markedly exceeded other variables. Discussion: In the present study PCT was found to be a more accurate diagnostic parameter for differentiating SIRS and sepsis, and therefore daily determinations of PCT may be helpful in the follow up of critically ill patients.

Objective. The aim of this study was to evaluate the Acute Physiology and Chronic Health Evaluation (APACHE) II, III and Simplified Acute Physiology Score II (SAPS II) as predictors of severity of organophosphate poisoning (OPP). Methods. This is a retrospective study of 48 patients with OPP who were admitted to the intensive care unit (ICU) for at least 24 h between 1997 and 2004. Demographic, laboratory, survival data and on day one APACHE II, III, SAPS II and Glasgow Coma Scale (GCS) were recorded, and correlations between these scores and severity of poisoning were performed. Results. Forty-eight patients were evaluated. Mechanical ventilation was required by 58% of patients. The mean APACHE II, III and SAPS II values were 11.5 ± 7.21, 42.1 ± 24.49 and 25.1 ± 15.76, respectively. Total dose and duration of atropine and of pralidoxime therapy, length of ICU stay and mortality all correlated with these clinical scoring tools. Conclusions. The APACHE II, III and SAPS II clinical scoring tools seem to predict the severity of organophosphate poisoning, and may have prognostic value.