Información del artículo
Resumen
Las escalas de puntuación de gravedad intentan integrar datos clínicos en una única variable numérica con capacidad para predecir el curso de un paciente. El beneficio indirecto de dichas escalas es ampliamente aceptado. En primer lugar, cuando estos sistemas se aplican en la investigación, los resultados pueden ser comparados más fácilmente y los ensayos clínicos son más objetivos y reproducibles. En segundo lugar, las puntuaciones pueden utilizarse en la evaluación de la calidad y las comparaciones de la mortalidad esperada y observada pueden ser usadas para evaluar la eficacia de la UCI. En tercer lugar, la puntuación de la gravedad de los cuadros en los pacientes de la UCI pueden ayudar a economistas y administradores en decisiones presupuestarias. En cuarto lugar, trabajar con sistemas de puntuación tiene un efecto formativo y puede ayudar a suplir la falta de experiencia en facultativos jóvenes. Se considera que existe un efecto directo cuando, en base a una puntuación, se inician, retiran o deniegan procedimientos diagnósticos o terapéuticos. Es necesario enfatizar que los indicadores pronósticos reflejan la evolución esperada para un grupo de pacientes, y su utilidad para tomar decisiones en relación con la atención a un paciente individual es muy limitada. Un sistema predictivo estadístico no debería nunca liberar al médico de su deber de tener en cuenta al paciente en conjunto para sus decisiones. El pronóstico basado en escalas de puntuación sigue, por tanto, suponiendo sólo una pequeña porción del complejo puzzle que es el proceso de decisión del médico
Palabras clave:
Sepsis
Fracaso multiorgánico
Escalas de gravedad
Pronóstico
The risk scoring systems try to integrate clinical data into an unique numerical variable with capacity to predict the course of a given patient. The indirect benefit of these scales is widely accepted. In the first place, when these systems are applied to clinical research, the results can be more easily compared and the clinical trials are more objetive and reproducibles. Secondly, the scores can be used in the quality evaluation and the comparisons of predicted and observed mortality can be used to evaluate the effectiveness of the ICU. Thirdly, the gravity score of the processes in the ICU patients can help economists and administrators in budgetary decisions. In fourth place, working with scoring systems has a formative effect, being able to help to replace the lack of experience in young doctors. It is considered that a direct effect exists when, based on a score, diagnostic or therapeutic procedures are started, retired or denyed. It is necessary to emphasize that the prognosis indexes reflect the awaited evolution for a group of patients, and its utility to make decisions concerning the attention to an individual patient is very limited. A statistical predictive system should never liberate the doctor of its duty of considering the whole patient when making any therapeutic decision
Key words:
Sepsis
Multiorgan failure
Prognosis index
Gravity scores
El Texto completo está disponible en PDF
Bibliografía
[1.]
L.M. Arregui, D.G. Moyes, J. Lipman, L.P. Fatti.
Comparison of disease severity scoring systems in septic shock.
Crit Care Med, 19 (1991), pp. 1165-1171
[2.]
S. Atkinson, D. Bihari, M. Smithies, K. Daly, R. Mason, I. McColl.
Identification of futility in intensive care.
Lancet, 334 (1994), pp. 1203-1206
[3.]
A.E. Baue.
Multiple, progressive, or sequential systems failure: a syndrome of the 1970s.
Arch Surg, 110 (1975), pp. 779-781
[4.]
G.R. Bernard, G. Doig, L. Hudson, M. Lamy, J.R. LeGall, A. Morris, et al.
Quantification of organ failure for clinical trials and clinical practice.
Am J Respir Crit Care Med, 151 (1995), pp. A323
[5.]
G.R. Bernard, A.P. Wheeler, J.A. Russell, R. Schein, W.R. Summer, K.P. Steinberg, et al.
The effects of ibuprofen on the physiology and survival of patients with sepsis. The Ibuprofen in Sepsis Study Group.
N Engl J Med, 336 (1997), pp. 912-918
[6.]
M.M. Berger, A. Marazzi, J. Freeman, R. Chioléro.
Evaluation of the consistency of Acute Physiology And Chronic Health Evaluation (APACHE II) scoring in a surgical intensive care unit.
Crit Care Med, 20 (1992), pp. 1681-1687
[7.]
M.J.O.E. Bertleff, H.A. Bruining.
How should MODS be assessed? A review of the variation in current scoring systems.
Eur J Surg, 163 (1997), pp. 405-409
[8.]
J.M. Bohnen, R.A. Mustard, S.E. Oxholm, B.D. Schouten.
APACHE II score and abdominal sepsis: a prospective study.
Arch Surg, 123 (1988), pp. 225-229
[9.]
R.C. Bone, R.A. Balk, F.B. Cerra, R.P. Dellinger, A.M. Fein, W.A. Knaus, et al.
Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine.
Chest, 101 (1992), pp. 1644-1655
[10.]
R.C. Bone.
Immunologic dissonance: a continuing evolution in our understanding of the systemic inflammatory response syndrome (SIRS) and the multiple organ dysfunction syndrome (MODS).
Ann Intern Med, 125 (1996), pp. 680-687
[11.]
J.R. Border, J. Hassett, J. LaDuca, R. Seibel, S. Steinberg, B. Mills, et al.
The gut origin septic states in blunt multiple trauma (ISS = 40) in the ICU.
Ann Surg, 206 (1987), pp. 427-448
[12.]
K. Bosscha, K. Reijnders, P.F. Hulstaert, A. Algra, C. Van der Werken.
Prognostic scoring systems to predict outcome in peritonitis and intra- abdominal sepsis.
Br J Surg, 84 (1997), pp. 1532-1534
[13.]
C. Brun-Buisson, F. Doyon, J. Carlet.
el French Bacteremia-Sepsis Study Group. Bacteremia and severe sepsis in adults: a multicenter prospective survey in ICUs and wards of 24 hospitals.
Am J Respir Crit Care Med, 154 (1996), pp. 617-624
[14.]
T. Calandra, J.D. Baumgartner, G.E. Grau, M.M. Wu, P.H. Lambert, J. Schellekens, et al.
Prognostic values of tumor necrosis factor/cachectin, interleukin-1, interferon-alpha and interferon-gamma in the serum of patients with septic shock.
J Infect Dis, 161 (1990), pp. 982-987
[15.]
T. Calandra, J. Gerain, D. Heumann, J.D. Baumgartner, M.P. Glauser.
El Swiss-Dutch J5 Immunoglobulin Study Group. High circulating levels of interleukin-6 in patients with septic shock: evolution during sepsis, prognostic value, and interplay with other cytokines.
Am J Med, 91 (1991), pp. 23-29
[16.]
L.C. Casey, R.A. Balk, R.C. Bone.
Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome.
Ann Intern Med, 119 (1993), pp. 771-778
[17.]
F.B. Cerra, F. Negro, J. Abrams.
APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients.
Arch Surg, 125 (1990), pp. 519-522
[18.]
J.M. Civetta, J.A. Hudson-Civetta, L.D. Nelson.
Evaluation of APACHE II for costcontainment and quality assurance.
Ann Surg, 212 (1990), pp. 226-274
[19.]
G.P. Copeland, D.R. Jones, A. Wilcox, P.L. Harris.
Comparative vascular audit using the POSSUM scoring system.
Ann R Coll Surg Engl, 75 (1993), pp. 5-7
[20.]
G.P. Copeland, P. Sagar, J. Brennan, G. Roberts, J. Ward, P. Comford, et al.
Risk-adjusted analysis of surgeon performance: a 1-year study.
Br J Surg, 82 (1995), pp. 408-411
[21.]
G.P. Copeland, D. Jones, M. Walters.
POSSUM: a scoring system for surgical audit.
Br J Surg, 78 (1991), pp. 355-360
[22.]
D.J. Cullen, J.M. Civetta, B.A. Briggs, L.C. Ferrara.
Therapeutic intervention scoring system: a method for quantitative comparison of patient care.
Crit Care Med, 2 (1974), pp. 57-60
[23.]
B. Derkx, A. Marchant, M. Goldman, R. Bijlmer, S. Van Deventer.
High levels of interleukin-10 during the initial phase of fulminant meningococcal septic shock.
J Infect Dis, 171 (1995), pp. 229-232
[24.]
R. Dionigi, L. Dominioni, V. Jemos, R. Cremaschi, F. Bobbio-Pallavicini, A. Ballabio.
Sepsis score and complement factor B for monitoring severely septic surgical patients and for predicting their survival.
Eur Surg Res, 17 (1985), pp. 269-280
[25.]
L. Dominioni, R. Dionigi, M. Zanello, R. Monico, R. Cremaschi, R. Dionigi, et al.
Sepsis Score and acute-phase protein response as predictors of outcome in septic surgical patients.
Arch Surg, 122 (1994), pp. 141-146
[26.]
L. Doughty, J.A. Carcillo, S. Kaplan, J. Janosky.
The compensatory antiinflammatory cytokine interleukin 10 response in pediatric sepsisinduced multiple organ failure.
Chest, 113 (1998), pp. 1625-1631
[27.]
B. Eiseman, R. Beart, L. Norton.
Multiple organ failure.
Surg Gynecol Obstet, 144 (1977), pp. 323-327
[29.]
E. Faist, A.E. Baue, H. Dittmer, G. Heberer.
Multiple organ failure in polytrauma patients.
J Trauma, 23 (1983), pp. 775-787
[30.]
D.E. Fry, L. Pearlstein, R.L. Fulton, H.C. Jr. Polk.
Multiple system organ failure: the role of uncontrolled infection.
Arch Surg, 115 (1980), pp. 136-140
[31.]
D.E. Fry, R.N. Garrison, R.C. Heitsch, K. Calhoun, HC Jr. Polk.
Determinants of death in patients with intraabdominal abscess.
Surgery, 88 (1980), pp. 517-523
[32.]
G. Giangiuliani, A. Mancini, D. Gui.
Validation of a severity of illness score (APACHE II) in a surgical intensive care unit.
Intensive Care Med, 15 (1989), pp. 519-522
[33.]
R.J. Goris, T.P. De Boeckhorst, J.K. Nuytinck, J.S. Gimbrere.
Multiple-organ failure: generalized autodestructive inflammation?.
Arch Surg, 120 (1985), pp. 1109-1115
[34.]
R.J.A. Goris, H.K.S. Nuytinck, H. Redl.
Scoring systems and predictors of ARDS and MOR.
First Vienna Shock Forum, part B, pp. 3-15
[35.]
C.E. Hack, E.R. De Groot, R.J. Felt-Bersma, J.H. Nuijens, R.J. Strack Van Schijndel, A.J. Eerenberg-Belmer, et al.
Increased plasma levels of interleukin-6 in sepsis.
Blood, 74 (1989), pp. 1704-1710
[36.]
D.R. Jones, G.P. Copeland, L. De Cossart.
Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit.
Br J Surg, 79 (1992), pp. 1293-1296
[37.]
A.R. Keene, D.J. Cullen.
Therapeutic Intervention Scoring System: Update 1983.
Crit Care Med, 11 (1983), pp. 1-3
[38.]
W.A. Knaus, J.E. Zimmerman, D.P. Wagner, E.A. Draper, D.E. Lawrence.
APACHE – acute physiology and chronic health evaluation: a physiologically based classification system.
Crit Care Med, 9 (1981), pp. 591-597
[39.]
V.A. Knaus, E.A. Draper, D.P. Wagner, J.E. Zimmerman.
Prognosis in acute organ-system failure.
Ann Surg, 202 (1985), pp. 685-693
[40.]
W.A. Knaus, E.A. Draper, D.P. Wagner, J.E. Zimmerman.
APACHE II: a severity of disease classification system.
Crit Care Med, 13 (1985), pp. 818-829
[41.]
W.A. Knaus, D.P. Wagner, E.A. Draper, J.E. Zimmerman, M. Bergner, P.G. Bastos, et al.
The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.
Chest, 100 (1991), pp. 1619-1636
[42.]
A. Le Gall, P. Loirat, A. Alperovitch, P. Glaser, C. Granthil, D. Mathieu, et al.
A simplified acute physiology score for ICU patients.
Crit Care Med, 12 (1984), pp. 975-977
[43.]
J. Le Gall, S. Lemeshow, F. Saulnier.
A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study.
JAMA, 270 (1993), pp. 2957-2963
[44.]
J.R. Le Gall, S. Lemeshow, G. Leleu, J. Klar, J. Huillard, X.I. Rue, et al.
Customized probability models for early severe sepsis in adult intensive care patients. Intensive Care Unit Scoring Group.
JAMA, 273 (1995), pp. 644-650
[45.]
J.R. Le Gall, J. Klar, S. Lemeshow, F. Saulnier, C. Alberti, A. Artigas, et al.
for the ICU scoring group: the Logistic Organ Dysfunction System. A new way to assess organ dysfunction in the intensive care unit.
JAMA, 276 (1996), pp. 802-810
[46.]
A.K. Lehmann, A. Halstensen, S. Sornes, O. Rokke, A. Waage.
High levels of interleukin 10 in serum are associated with fatality in meningococcal disease.
Infect Immun, 63 (1995), pp. 2109-2112
[47.]
S. Lemeshow, D. Teres, H. Pastides, J.S. Avrunin, J.S. Steingrub.
A method for predicting survival and mortality of ICU patients using objectively derived weights.
Crit Care Med, 13 (1985), pp. 519-525
[48.]
S. Lemeshow, D. Teres, J. Klar, J.S. Avrunin, S.H. Gehlbach, J. Rapoport.
Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients.
JAMA, 270 (1993), pp. 2478-2486
[49.]
J.C. Marshall, N.V. Christou, R. Horn, J.L. Meakins.
The microbiology of multiple organ failure: the proximal gastrointestinal tract as an occult reservoir of pathogens.
Arch Surg, 123 (1988), pp. 309-315
[50.]
J.C. Marshall, D.J. Cook, N.V. Christou, G.R. Bernard, C.L. Sprung, W.J. Sibbald.
Multiple Organ Dysfunction Score: a reliable descriptor of a complex clinical outcome.
Crit Care Med, 23 (1995), pp. 1638-1652
[51.]
J.C. Marshall, G. Bernard, J.R. Le Gall, N.V. Christou.
The measurement of organ dysfunction/failure as an ICU outcome.
Sepsis, 1 (1997), pp. 41-57
[52.]
S. Matsusue, S. Kashihara, S. Koizumi.
Prediction of mortality from septic shock in gastrointestinal surgery by probit analysis.
Jap J Surgery, 18 (1988), pp. 22-26
[53.]
G.J. McLauchlan, I.D. Anderson, I.S. Grant, K.C.H. Fearon.
Outcome of patients with abdominal sepsis treated in an intensive care unit.
Brit J Surg, 82 (1995), pp. 524-529
[54.]
L.D. MacLean, W.G. Mulligan, A.P. McLean, J.H. Duff.
Patterns of septic shock in man. A detailed study of 56 patients.
Ann Surg, 166 (1967), pp. 543-562
[55.]
J.L. Meakins, B. Wicklund, R.A. Forse, A.P. McLean.
The surgical intensive care unit: current concepts in infection.
Surg Clin North Am, 60 (1980), pp. 117-132
[56.]
R. Moreno, P. Morais.
Outcome prediction in intensive care: results of a prospective, multicentre, Portuguese study.
Intensive Can Med, 23 (1997), pp. 177-186
[57.]
D.J.J. Muckart, S. Bhagwanjee, P.A. Neijenhuis.
Prediction of the risk of death by APACHE II scoring in critically ill trauma patients without head injury.
Br J Surg, 83 (1996), pp. 1123-1127
[58.]
L.S. Murray, G.M. Teasdale, G.D. Murray, B. Jennett, J.D. Miller, J.D. Pickard, et al.
Does prediction of outcome alter patient management?.
Lancet, 341 (1993), pp. 1487-1491
[59.]
G. Pilz, K. Werdan.
Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock.
Infection, 18 (1990), pp. 253-262
[60.]
G. Pilz, S. Kaab, E. Kreutzer, K. Werdan.
Evaluation of definitions and parameters for sepsis assessment in patients after cardiac surgery.
Infection, 22 (1994), pp. 8-17
[61.]
R.W. Pine, M.J. Wertz, E.S. Lennard, E.P. Dellinger, C.J. Carrico, B.H. Minshew.
Determinants of organ malfunction or death in patients with intra-abdominal sepsis: a discriminant analysis.
Arch Surg, 118 (1983), pp. 242-249
[62.]
D. Pittet, S. Rangel-Frausto, N. Li, D. Tarara, M. Costigan, L. Rempe, et al.
Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients.
Intensive Care Med, 21 (1995), pp. 302-309
[63.]
D. Pittet, B. Thiévent, R.P. Wenzel, N. Li, G. Gurman, P.M. Suter.
Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients.
Intensive Care Med, 19 (1993), pp. 265-272
[64.]
D. Poenaru, N.V. Christou.
Clinical outcome of seriously ill surgical patients with intra-abdominal infection depends on both physiologic (APACHE II score) and immunologic (DTH score) alterations.
Ann Surg, 213 (1991), pp. 130-136
[65.]
H.C. Polk, C.L. Shields.
Remote organ failure: a valid sign of occult intra- abdominal infection.
Surgery, 81 (1977), pp. 310-318
[66.]
A. Porath, N. Eldar, I. Harman-Bohem, G. Gurman.
Evaluation of the APACHE Il scoring system in an Israeli intensive care unit.
Isrl Med Sci, 30 (1994), pp. 514-520
[67.]
E. Presterl, T. Staudinger, M. Pettermann, A. Lassnigg, H. Burgmann, S. Winkler, et al.
Cytokine profile and correlation to the APACHE III and MPM II scores in patients with sepsis.
Am J Respir Crit Care Med, 156 (1997), pp. 825-832
[68.]
M.S. Rangel-Frausto, D. Pittet, M. Costigan, T. Hwang, C.S. Davis, R.P. Wenzel.
The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study.
JAMA, 273 (1995), pp. 117-123
[69.]
J.H.C. Ranson, K.M. Rifkind, J.W. Turner.
Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis.
Surg Gynecol Obstet, 143 (1976), pp. 209-213
[70.]
K. Reinhart, C. Wiegand-Lohnert, F. Grimminger, M. Kaul, S. Withington, D. Treacher, et al.
Assessment of the safety and efficacy of the monoclonal anti-tumor necrosis factor antibody-fragment, MAK 195F, in patients with sepsis and septic shock: a multicenter, randomized, placebo-controlled, dose-ranging study.
Crit Care Med, 24 (1996), pp. 733-742
[71.]
J. Rogers, H.D. Fuller.
Use of daily Acute Physiology and Chronic Health Evaluation (APACHE) II scores to predict individual patient survival rate.
Crit Care Med, 22 (1994), pp. 1402-1405
[72.]
R.M.H. Roumen, T.J. Schers, H.H.M. De Boer, R.J.A. Goris.
Scoring systems for predicting outcome in acute haemorrhagic necrotizing pancreatitis.
Eur J Surg, 158 (1992), pp. 167-171
[73.]
K.M. Rowan, J.H. Kerr, E. Major, K. McPherson, A. Short, M.P. Vessey.
Intensive Care Society’s Acute Physiology And Chronic Health Evaluation (APACHE II) study in Britain and Ireland: a prospective, multicenter, cohort study comparing two methods for predicting outcome for adult intensive care patients.
Crit Care Med, 22 (1994), pp. 1392-1401
[74.]
E. Ruokonen, J. Takala, A. Kari, E. Alhava.
Septic shock and multiple organ failure.
Crit Care Med, 19 (1991), pp. 1146-1151
[75.]
P.M. Sagar, M.N. Hartley, B. Mancey-Jones, P.C. Sedman, J. May, J. Macfie.
Comparative audit of colorectal resection with the POSSUM scoring system.
Br J Surg, 81 (1994), pp. 1492-1494
[76.]
K.E. Sands, D.W. Bates, P.N. Lanken, P.S. Graman, P.L. Hibberd, K.L. Kahn, et al.
Epidemiology of sepsis syndrome in 8 academic medical centers.
JAMA, 278 (1997), pp. 234-240
[77.]
K.C. Sasse, E. Nauenberg, A. Long, B. Anton, H.J. Tucker, T. Hu.
Longterm survival after intensive care unit admission with sepsis.
Crit Care Med, 23 (1995), pp. 1040-1047
[78.]
A.J.H. Simpson, M.D. Smith, G.J. Weverling, Y. Suputtamongkol, B.J. Angus, W. Chaowagul, et al.
Prognostic value of cytokine concentrations (tumor necrosis factor-alpha, interleukin-6, and interleukin-10) and clinical parameters in severe melioidosis.
J Infect Dis, 181 (2000), pp. 621-625
[79.]
T. Skau, P.O. Nyström, C. Carlson.
Severity of illness in intra-abdominal infection.
Arch Surg, 120 (1993), pp. 152-158
[80.]
J.J. Skillman, L.S. Bushnell, H. Goldman, W. Silen.
Respiratory failure, hypotension, sepsis, and jaundice: a clinical syndrome associated with lethal hemorrhage from acute stress ulceration of the stomach.
Am J Surg, 117 (1969), pp. 523-530
[81.]
Society of Critical Care Medicine Ethics Committee. Consensus statement on the triage of critically ill patients.
JAMA, 271 (1994), pp. 1200-1203
[82.]
L.E. Stevens.
Gauging the severity of surgical sepsis.
Arch Surg, 118 (1983), pp. 1190-1196
[83.]
D. Teres, S. Lemeshow.
Using severity measures to de scribe high performance ICUs.
Crit Care Clin, 9 (1993), pp. 543-554
[84.]
N.L. Tilney, G.L. Bailey, A.P. Morgan.
Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care.
Ann Surg, 178 (1973), pp. 117-122
[85.]
J.T. Van Dissel, P. Van Langevelde, R.G.J. Westendorp, K. Kwappenberg, M. Frölich.
Anti-inflammatory cytokine profile and mortality in febrile patients.
Lancet, 351 (1998), pp. 950-953
[86.]
J.L. Vincent.
Dear SIRS, I’m sorry to say that I don’t like you.
Crit Care Med, 25 (1997), pp. 372-374
[87.]
J.L. Vincent, A. De Mendonça, F. Cantraine, R. Moreno, J. Takala, P.M. Suter, et al.
Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine.
Crit Care Med, 26 (1998), pp. 1793-1800
[88.]
A. Waage, P. Brandtzaeg, A. Halstensen, P. Kierulf, T. Espevik.
The complex pattern of cytokines in serum from patients with meningococcal septic shock: association between interleukin 6, interleukin 1, and fatal outcome.
J Exp Med, 169 (1989), pp. 333-338
[89.]
A. Waage, A. Halstensen, T. Espevik.
Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease.
Lancet, 1 (1997), pp. 355-357
[90.]
H. Wacha, M.M. Linder, U. Feldman, G. Wesch, E. Gundlach, R.A. Steifensand.
Mannheim Peritonitis Index -prediction of risk of death from peritonitis: construction of a statistical and validation of an empirically based index.
Theoretical Surg, 1 (1987), pp. 169-177
[91.]
R.G. Westendorp, J.A. Langermans, T.W. Huizinga, C.L. Verweij, A. Sturk.
Genetic influence on cytokine production and fatal meningococcal disease.
Lancet, 349 (1997), pp. 1912-1913
[92.]
M.S. Whiteley, D.R. Prytherch, B. Higgins, P.C. Weaver, W.G. Prout.
An evaluation of the POSSUM surgical scoring system.
Br J Surg, 83 (1996), pp. 812-815
[93.]
P. Wilairatana, N.S. Noan, S. Chinprasatsak, K. Prodeengam, D. Kityaporn, S. Looareesuwan.
Scoring systems for predicting outcomes of critically ill patients in northeastern Thailand.
Southeast Asian J Trop Med Public Health, 26 (1995), pp. 66-72
[94.]
D.T. Wong, S.L. Crofts, M. Gómez, G.P. McGuire, R.J. Byrick.
Evaluation of predictive ability of APACHE II system and hospital outcome in anadian intensive care unit patients.
Crit Care Med, 23 (1995), pp. 1177-1183
[95.]
C.H. Wortel, M.A. Von der Möhlen, S.J. Van Deventer, C.L. Sprung, M. Jastremski, et al.
Effectiveness of a human monoclonal anti-endotoxin antibody (HA-1A) in gram-negative sepsis: relationship to endotoxin and cytokine levels.
J Infect Dis, 166 (1992), pp. 1367-1374
Copyright © 2001. Asociación Española de Cirujanos
