No abstract

Progress in the study of sepsis has been hampered by the lack of a suitable system for grading its severity. Systems suggested for scoring sepsis have been based either on its systemic effects (APACHE II) or on a mixture of local and systemic variables (sepsis score). The APACHE II and sepsis scores were applied to patients with intra-abdominal sepsis of more than 3 days' duration, to determine if local or systemic factors were more important in predicting survival. Of 45 patients studied, 14 died. The sepsis score for non-survivors (median 21.5, range 11-32) was significantly higher than for survivors (median 14, range 10-26, P less than 0.05). There was overlap between the two groups, such that an individual score had no predictive value. The local component of the sepsis score was not significantly increased in non-survivors (P less than 0.05), but the systemic component was (P less than 0.05). The APACHE II score for non-survivors (median 24, range 15-38) was significantly higher than for survivors (median 12, range 3-21), and correctly identified 13 of the 14 fatalities. Both the systemic and non-systemic components (age and chronic disease) were significantly higher among the latter. The APACHE II was more effective than the sepsis score in predicting survival. We conclude that any system used for scoring sepsis should be based on systemic rather than local effects. At present the APACHE II score is preferred.

The force-frequency characteristics and maximal relaxation rate of the adductor pollicis muscle were measured before and after 48 hours of intravenous loading with glucose (104-5 kJ (25 kcal)/ kg/24 h) and potassium (20 mmol(mEq)/500 ml glucose) in eight undernourished patients about to undergo surgery. Both variables of skeletal muscle performance, which were depressed when compared with data from 100 healthy volunteers, improved significantly after glucose-potassium loading. The improvement was accompanied by restoration of muscle glycogen values and return of respiratory exchange ratios towards unity.These results imply that if muscle power is a yardstick for preoperative nutritional rehabilitation then a simple regimen of energy-electrolyte repletion may be cost effective in preparing undernourished patients for major surgery.

Our objective was to examine the effect of biosynthetic human growth hormone (BSHGH) on protein and energy metabolism in patients on full intravenous nutrition (IVN). Fifteen patients who had been established on IVN were allocated at random to receive either BSHGH (0.1 mg/kg/day) or placebo daily for 7 days. All patients received the same feeding regimen which contaminated 14 gN, 1000 kcal of glucose and 1000 kcal of fat (Intralipid) daily. The mean nitrogen balance for days 4 to 7 was significantly more positive with BSHGH (7.0 +/- 0.6 gN/day) than with placebo (4.4 +/- 0.7 gN/day). The BSHGH group were lighter (53 +/- 4.6 kg body weight) than controls (68 +/- 5.1 kg), but the difference was not significant. Resting energy expenditure (expressed as percentage of day 1) increased throughout the study in patients receiving BSHGH (day 7, 120.8 +/- 5.5%), whereas in patients receiving placebo it remained stable (day 7, 98.9 +/- 2.7%). The nonprotein respiratory quotients were similar for BSHGH (mean days 4-7, 0.94 +/- 0.04) and placebo (mean days 4-7, 0.93 +/- 0.01) (p greater than 0.05). This study demonstrates more positive nitrogen balance, which may in part be due to different substrate loads, and an increase in energy expenditure in patients receiving BSHGH.