Общая реаниматология (Oct 2016)
Phenylcarboxylic Acids in The Assessment of The Severity of Patient Condition and The Efficiency of Intensive Treatment in Critical Care Medicine
Abstract
The development of accurate and applicable methods to assess the severity of patient condition is an urgent need in critical care medicine.The goal of the study was to determine whether the quantitave evaluation of phenylcarboxylic acids (PhCAs) concentrations in blood might be employed to assess the severity of patient condition and treatment efficiency intensive care unit.Materials and methods. Clinical and laboratory findings in patients (n=58) with acute surgical diseases of abdominal organs were registered on the day of admission to intensive care unit and during follow-up control including lactate level and blood serum PhCA concentrations of phenyllactic (PhLA), p#hydroxyphenyllactic (p-HPhLA) and phydroxyphenylacetic (p#HPhAA) acids. Patients' condition was assessed using APACHE II and SOFA international scales. PhCA concentrations were determined by gas chromatography. The reference group included healthy blood donors (n=25).Results. PhLA, p-HPhAA, p-HPhLA levels and total concentration of the three PhCAs were shown to be in direct correlation with APACHE II score (rs: 0.624; 0.757; 0.763 and 0.804, respectively; P<0.001). When testing PhCAs as a molecular prognostic criteria, areas under ROC#curves (AUC) were within the range of 0.800—0.900 (P<0.001). Therewith the molecular prognostic criteria were comparable with APACHE II multi#parameter scale by accuracy: AUCAPACHE II was 0.897 (P<0.001). Lactate level dynamics as a prognostic criterion was inferior in accuracy to the dynamics of PhCA total concentration: AUCС lactate, % 0.667 (P=0.071) vs AUCС 3PhCAs, % 0.862 (P<0.001). In patients with documented bacterial inflammatory complications PhCA level was 2.5 times higher (P<0,001, n=35) and p#HPhLA level was 1.5 times higher than in patients without infectious complications (P=0.048, n=23).Conclusion. The findings provide evidence for the inclusion of PhCAs (PhLA, p-HPhAA, p-HPhLA, 3PhCAs) in clinical practice as biomarkers of the severity of condition in patients with surgical diseases of abdominal organs. The study showed that change in PhCA serum concentrations reflected the dynamics of patient condition and might be used for objective monitoring of the treatment.
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