Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 9/2008

01-09-2008 | Original

Does severe non-infectious SIRS differ from severe sepsis?

Results from a multi-centre Australian and New Zealand intensive care unit study

Authors: Joel M. Dulhunty, Jeffrey Lipman, Simon Finfer, the Sepsis Study Investigators for the ANZICS Clinical Trials Group

Published in: Intensive Care Medicine | Issue 9/2008

Login to get access

Abstract

Objective

To compare the time course of organ dysfunction/failure, mortality and cause of death in patients with severe sepsis (SS) and patients with severe non-infectious systemic inflammatory response syndrome (SNISIRS).

Design

Secondary analysis of a multi-centre inception cohort study.

Setting

Twenty-three multidisciplinary intensive care units (ICUs) in Australia and New Zealand.

Patients and participants

3,543 ICU admissions ≥48 h or <48 h if SIRS and organ dysfunction present.

Interventions

None.

Measurements and results

ICU prevalence of SS and SNISIRS was 20% (707/3,543) and 28% (980/3,543), respectively. ICU mortality was similar in patients with SNISIRS and with SS (25 vs. 27%, P = 0.40). Central nervous system (CNS) failure occurred more frequently in patients with SNISIRS (33 vs. 22%, P < 0.001) and resulted in death more commonly than in SS (relative risk = 1.6, 95% confidence interval 1.4–1.7, P < 0.001). The time to peak organ dysfunction (0.67 vs. 0.91 days, P = 0.004), overall episode length (3.6 vs. 5.6 days, P < 0.001) and ICU stay (geometric mean: 4.1 vs. 5.8 days, P < 0.001) were significantly shorter in patients with SNISIRS.

Conclusions

Whilst SNISIRS and SS have similarities, including their crude mortality rate, important differences exist. SNISIRS is more common on admission to the ICU, and is more commonly coupled with CNS dysfunction and death from neurological failure.

Descriptors

SIRS/sepsis: clinical studies.
Appendix
Available only for authorised users
Literature
1.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) 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 101:1644–1655PubMedCrossRef
2.
Seely AJ, Christou NV (2000) Multiple organ dysfunction syndrome: exploring the paradigm of complex nonlinear systems. Crit Care Med 28:2193–2200PubMedCrossRef
3.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 29:530–538PubMed
4.
Muckart DJJ, Bhagwanjee S (1997) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 25:1789–1795PubMedCrossRef
5.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D (2006) Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 34:344–353PubMedCrossRef
6.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310PubMedCrossRef
7.
Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J (2004) Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med 30:589–596PubMedCrossRef
8.
Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554PubMedCrossRef
9.
Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K (2003) Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 31:2332–2338PubMedCrossRef
10.
Guidet B, Aegerter P, Gauzit R, Meshaka P, Dreyfuss D (2005) Incidence and impact of organ dysfunctions associated with sepsis. Chest 127:942–951PubMedCrossRef
11.
Levy MM, Macias WL, Vincent JL, Russell JA, Silva E, Trzaskoma B, Williams MD (2005) Early changes in organ function predict eventual survival in severe sepsis. Crit Care Med 33:2194–2201PubMedCrossRef
12.
Russell JA, Singer J, Bernard GR, Wheeler A, Fulkerson W, Hudson L, Schein R, Summer W, Wright P, Walley KR (2000) Changing pattern of organ dysfunction in early human sepsis is related to mortality. Crit Care Med 28:3405–3411PubMedCrossRef
13.
Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709PubMedCrossRef
14.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710PubMedCrossRef
15.
Sprung CL, Sakr Y, Vincent JL, Le Gall JR, Reinhart K, Ranieri VM, Gerlach H, Fielden J, Groba CB, Payen D (2006) An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence In Acutely Ill Patients (SOAP) study. Intensive Care Med 32:421–427PubMedCrossRef
16.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRef
17.
Vincent JL (2006) Organ dysfunction in patients with severe sepsis. Surg Infect (Larchmt) 7(Suppl 2):S69–S72
18.
Nfor TK, Walsh TS, Prescott RJ (2006) The impact of organ failures and their relationship with outcome in intensive care: analysis of a prospective multicentre database of adult admissions. Anaesthesia 61:731–738PubMedCrossRef
19.
Hugonnet S, Harbarth S, Ferriere K, Ricou B, Suter P, Pittet D (2003) Bacteremic sepsis in intensive care: temporal trends in incidence, organ dysfunction, and prognosis. Crit Care Med 31:390–394PubMedCrossRef
20.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) Prognosis in acute organ-system failure. Ann Surg 202:685–693PubMedCrossRef
21.
Afessa B, Green B, Delke I, Koch K (2001) Systemic inflammatory response syndrome, organ failure, and outcome in critically ill obstetric patients treated in an ICU. Chest 120:1271–1277PubMedCrossRef
22.
Marshall JC (2000) SIRS and MODS: what is their relevance to the science and practice of intensive care? Shock 14:586–589PubMedCrossRef
23.
Suntharalingam G, Perry MR, Ward S, Brett SJ, Castello-Cortes A, Brunner MD, Panoskaltsis N (2006) Cytokine storm in a phase 1 trial of the anti-CD28 monoclonal antibody TGN1412. N Engl J Med 355:1018–1028PubMedCrossRef
Metadata
Title
Does severe non-infectious SIRS differ from severe sepsis?
Results from a multi-centre Australian and New Zealand intensive care unit study
Authors
Joel M. Dulhunty
Jeffrey Lipman
Simon Finfer
the Sepsis Study Investigators for the ANZICS Clinical Trials Group
Publication date
01-09-2008
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1160-2

Other articles of this Issue 9/2008

Intensive Care Medicine 9/2008 Go to the issue

Brief Report

High frequency oscillatory ventilation for respiratory failure due to RSV bronchiolitis

Erratum

Modulation of regional nitric oxide metabolism: Blood glucose control or insulin?

Brief Report

Protein C concentrate to restore physiological values in adult septic patients

Editorial

AIDS is coming to your ICU: be prepared for acute bowel injury and acute intestinal distress syndrome…

Original

Non-invasive ventilation as primary ventilatory support for infants with severe bronchiolitis

Correspondence

ACE insertion/deletion polymorphism in sepsis and acute respiratory distress syndrome