Monitoring parameters of energy metabolism in patients with acute abdomen--possible prognostic factors?
Abstract
The prognosis of patients treated on account of serious surgical abdominal attacks is influenced apart from the severity of the condition also by failure of the energy metabolism. Some disorders of the milieu intérieur are the result of a deficient energy situation, energy failure participates in the development of organ disorders, failure and death.
The cellular energy metabolism can be expressed as the so-called "redox-state" which can be assessed directly by estimating the ratio of ketone substances in arterial blood - AKBR - Arterial Ketone Body Ratio. The objective of the study was to test whether assessment of the AKBR index is possible, what is its importance in clinical practice and to compare its validity in particular with the commonly used scoring system APACHE II and MPI.
The authors evaluated 24 patients operated on account of obstruction of the large intestine and 8 patients operated on account of peritonitis of intestinal origin. While evaluation by means of the MPI score helped to assess the prognosis, evaluation by the APACHE II score did not contribute to prediction of the development of the disease.
Assessment of AKBR was of prognostic value only in patients who died during treatment. Conclusion: For practical use it is necessary to improve and simplify biochemical examination and scoring systems and learn how to utilize them better.