In order to find out the best prognostic index in terms of simplicity, precision, time and cost efficiency, and comfort for the patients, the author measured several biological varibles in 100 surgical intensive care unit patients at the time of
their
admission and 24 hours thereafter starting November 1, 1992. The individual prognostic potentials of some parameters were evaluated by comparing nonsurvivors with survivors. Here, Chi-square test, Wilcoxon's rank sum test. and Spearman's
correlation
analysis were used. The validity of APACHE III scoring systems in Korea was also evaluated. In this observation, the elucidation of the prognostic value of arterial ketone body ratio (AKBR), which is known to accurately reflect hepatocytic ATP
generating potentials, was emphasized.
There were 18 nemorrhagic shock 35 sepsis cases, 41 major trauma or major operation cases, and 6 others. Among the 100 patients, 30 explred and 70 survived.
With an increase in APACHE III score, the increased hospital death rate was observed.
Admission AKBR level of nonsurvivors (n=30) was 0.57±0.07 (mean±standard error). but the survivors (n=70) was 1.22±0.06 (p<0.01). The patients who showed admission AKBR below 0.5 (n=13) all died. The patients with admission AKBR above 1.0
(n=45)
all
but one survived. Among the patients who demonstrated admission AKBR between 0.5~0.9, THERE WAS NO SIGNIFICANT CHANGE BETWEEN ADMISSION akbr AND 24 HOURS akbr IN NONSURVIVORS. But in survivors, 24 hour AKBR increased significantly (p<0.05).
The differences between nonsurvivors and survivors in the level of serum lactate (p<0.01), PNI (p<0.01), and platelet count (p<0.01) also revealed some prognostic potentials. The APACHE III score was correlated with AKBR (p<0.01), PNI (P<0.01 in
nonsurvivors, p<0.05 in survivors), and the level of serum lactate (p<0.05 in survivors).
Although the number of observation is small, some parameters showed marked prognostic potentials and in particular AKBR seems to be the best single index in the management of critically ill patients.
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