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International Journal of Emergency Medicine

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Open Access 01-12-2012 | Original Research

The duration of SIRS before organ failure is a significant prognostic factor of sepsis

Authors: Hiroki Sugita, Yoshihiro Kinoshita, Hideo Baba

Published in: International Journal of Emergency Medicine | Issue 1/2012

Abstract

Background

The mortality rate of patients complicated with sepsis-associated organ failure remains high in spite of intensive care treatment. The purpose of this study was to define the duration of systemic inflammatory response syndrome (SIRS) before organ failure (DSOF) and determine the value of DSOF as a prognostic factor in septic patients.

Methods

This retrospective cohort study was conducted in an 11-bed medical and surgical intensive care unit (ICU) in a university hospital. The primary endpoint was in-hospital mortality of the septic patients.

Results

One hundred ten septic patients with organ failure and/or shock were enrolled in this study. The in-hospital mortality rate was 36.9%. The median DSOF was 28.5 h. As a metric variable, DSOF was a statistically significant prognostic factor according to univariate analysis (survivor: 74.7 ± 9.6 h, non-survivor: 58.8 ± 16.5 h, p = 0.015). On the basis of the ROC curve, we defined an optimal cutoff of 24 h, with which we divided the patients as follows: group 1 (n = 50) comprised patients with a DSOF ≤24 h, and group 2 (n = 60) contained patients with a DSOF >24 h. There were statistically significant differences in the in-hospital mortality rate between the two groups (52.0% vs. 25.0%, p = 0.004). Furthermore, by multivariate analysis, DSOF ≤24 h (odds ratio: 5.89, 95% confidence interval: 1.46-23.8, p = 0.013) was a significant independent prognostic factor.

Conclusion

DSOF may be a useful prognostic factor for severe sepsis.

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Martin GS, Mannino DM, Eaton S, et al.: The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003, 348: 1546–1554. 10.1056/NEJMoa022139PubMedCrossRef

Micek ST, Roubinian N, Heuring T, et al.: Before-after study of a standardized hospital order set for the management of septic shock. Crit Care Med 2006, 34: 2707–2713. 10.1097/01.CCM.0000241151.25426.D7PubMedCrossRef

Garnacho-Montero J, Aldabo-Pallas T, Garnacho-Montero C, et al.: Timing of adequate antibiotic therapy is a greater determinant of outcome than are TNF and IL-10 polymorphisms in patients with sepsis. Crit Care 2006, 10: R111. 10.1186/cc4995PubMedCentralPubMedCrossRef

Cauchie P, Cauchie C, Boudjeltia KZ, et al.: Diagnosis and prognosis of overt disseminated intravascular coagulation in a general hospital – meaning of the ISTH score system, fibrin monomers, and lipoprotein-C-reactive protein complex formation. Am J Hematol 2006, 81: 414–419. 10.1002/ajh.20597PubMedCrossRef

Knaus WA, Draper EA, Wagner DP, et al.: APACHE II: a severity of disease classification system. Crit Care Med 1985, 13: 818–829. 10.1097/00003246-198510000-00009PubMedCrossRef

Park BH, Park MS, Kim YS, et al.: Prognostic utility of changes in N-terminal pro-brain natriuretic Peptide combined with sequential organ failure assessment scores in patients with acute lung injury/acute respiratory distress syndrome concomitant with septic shock. Shoc 2011, 36: 109–114. 10.1097/SHK.0b013e31821d8f2dCrossRef

Charles PE, Ladoire S, Snauwaert A, et al.: Impact of previous sepsis on the accuracy of procalcitonin for the early diagnosis of blood stream infection in critically ill patients. BMC Infect Dis 2008, 8: 163. 10.1186/1471-2334-8-163PubMedCentralPubMedCrossRef

Dellinger RP, Carlet JM, Masur H, et al.: Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004, 32: 858–873. 10.1097/01.CCM.0000117317.18092.E4PubMedCrossRef

Dremsizov T, Clermont G, Kellum JA, et al.: Severe sepsis in community-acquired pneumonia: when does it happen, and do systemic inflammatory response syndrome criteria help predict course? Chest 2006, 129: 968–978. 10.1378/chest.129.4.968PubMedCrossRef

10.

Alberti C, Brun-Buisson C, Chevret S, et al.: Systemic inflammatory response and progression to severe sepsis in critically ill infected patients. Am J Respir Crit Care Med 2005, 171: 461–468.PubMedCrossRef

11.

American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992, 20: 864–874. 10.1097/00003246-199206000-00025CrossRef

12.

Vincent JL, de Mendonca A, Cantraine F, 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 1998, 26: 1793–1800. 10.1097/00003246-199811000-00016PubMedCrossRef

13.

Gando S, Wada H, Asakura H, et al.: Evaluation of new Japanese diagnostic criteria for disseminated intravascular coagulation in critically ill patients. Clin Appl Thromb Hemost 2005, 11: 71–76. 10.1177/107602960501100108PubMedCrossRef

14.

Gando S, Iba T, Eguchi Y, et al.: A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria. Crit Care Med 2006, 34: 625–631.PubMed

15.

Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, et al.: Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003, 31: 2742–2751. 10.1097/01.CCM.0000098031.24329.10PubMedCrossRef

16.

Marshall JC, Maier RV, Jimenez M, et al.: Source control in the management of severe sepsis and septic shock: an evidence-based review. Crit Care Med 2004, 32: S513-S526. 10.1097/01.CCM.0000143119.41916.5DPubMedCrossRef

17.

Jimenez MF, Marshall JC: Source control in the management of sepsis. Intensive Care Med 2001,27(Suppl 1):S49-S62.PubMedCrossRef

18.

Amato MB, Barbas CS, Medeiros DM, et al.: Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med 1998, 338: 347–354. 10.1056/NEJM199802053380602PubMedCrossRef

19.

LeDoux D, Astiz ME, Carpati CM, et al.: Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 2000, 28: 2729–2732. 10.1097/00003246-200008000-00007PubMedCrossRef

20.

Martin C, Viviand X, Leone M, et al.: Effect of norepinephrine on the outcome of septic shock. Crit Care Med 2000, 28: 2758–2765.PubMedCrossRef

21.

Rivers E, Nguyen B, Havstad S, et al.: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368–1377. 10.1056/NEJMoa010307PubMedCrossRef

22.

Brun-Buisson C, Doyon F, Carlet J, et al.: Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. Jama 1995, 274: 968–974. 10.1001/jama.1995.03530120060042PubMedCrossRef

23.

Tsai MH, Peng YS, Chen YC, et al.: Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock. Hepatology 2006, 43: 673–681. 10.1002/hep.21101PubMedCrossRef

24.

Moreau R, Hadengue A, Soupison T, et al.: Septic shock in patients with cirrhosis: hemodynamic and metabolic characteristics and intensive care unit outcome. Crit Care Med 1992, 20: 746–750. 10.1097/00003246-199206000-00008PubMedCrossRef

25.

Thomsen RW, Hundborg HH, Lervang HH, et al.: Diabetes mellitus as a risk and prognostic factor for community-acquired bacteremia due to enterobacteria: a 10-year, population-based study among adults. Clin Infect Dis 2005, 40: 628–631. 10.1086/427699PubMedCrossRef

26.

Lujan M, Gallego M, Fontanals D, et al.: Prospective observational study of bacteremic pneumococcal pneumonia: effect of discordant therapy on mortality. Crit Care Med 2004, 32: 625–631. 10.1097/01.CCM.0000114817.58194.BFPubMedCrossRef

27.

Mesters RM, Mannucci PM, Coppola R, et al.: Factor VIIa and antithrombin III activity during severe sepsis and septic shock in neutropenic patients. Blood 1996, 88: 881–886.PubMed

28.

Ferreira FL, Bota DP, Bross A, et al.: Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001, 286: 1754–1758. 10.1001/jama.286.14.1754PubMedCrossRef

29.

Moreno R, Vincent JL, Matos R, et al.: The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med 1999, 25: 686–696. 10.1007/s001340050931PubMedCrossRef

Title: The duration of SIRS before organ failure is a significant prognostic factor of sepsis
Authors: Hiroki Sugita
Yoshihiro Kinoshita
Hideo Baba
Publication date: 01-12-2012
Publisher: Springer Berlin Heidelberg
Published in: International Journal of Emergency Medicine / Issue 1/2012
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/1865-1380-5-44

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The duration of SIRS before organ failure is a significant prognostic factor of sepsis

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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