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
Critical Care
Published in: Critical Care 2/2014

Open Access 01-04-2014 | Research

Risk stratification and prognostic performance of the predisposition, infection, response, and organ dysfunction (PIRO) scoring system in septic patients in the emergency department: a cohort study

Authors: Yun-Xia Chen, Chun-Sheng Li

Published in: Critical Care | Issue 2/2014

Login to get access

Abstract

Introduction

The predisposition, infection, response and organ dysfunction (PIRO) staging system was designed as a stratification tool to deal with the inherent heterogeneity of septic patients. The present study was conducted to assess the performance of PIRO in predicting multiple organ dysfunction (MOD), intensive care unit (ICU) admission, and 28-day mortality in septic patients in the emergency department (ED), and to compare this scoring system with the Mortality in Emergency Department Sepsis (MEDS) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores.

Methods

Consecutive septic patients (n = 680) admitted to the ED of Beijing Chao-Yang Hospital were enrolled. PIRO, MEDS, and APACHE II scores were calculated for each patient on ED arrival. Organ function was reassessed within 3 days of enrollment. All patients were followed up for 28 days. Outcome criteria were the development of MOD within 3 days, ICU admission or death within 28 days after enrollment. The predictive ability of the four components of PIRO was analyzed separately. Receiver operating characteristic (ROC) curve and logistic regression analysis were used to assess the prognostic and risk stratification value of the scoring systems.

Results

Organ dysfunction independently predicted ICU admission, MOD, and 28-day mortality, with areas under the ROC curve (AUC) of 0.888, 0.851, and 0.816, respectively. The predictive value of predisposition, infection, and response was weaker than that of organ dysfunction. A negative correlation was found between the response component and MOD, as well as mortality. PIRO, MEDS, and APACHE II scores significantly differed between patients who did and did not meet the outcome criteria (P < 0.001). PIRO and APACHE II independently predicted ICU admission and MOD, but MEDS did not. All three systems were independent predictors of 28-day mortality with similar AUC values. The AUC of PIRO was 0.889 for ICU admission, 0.817 for MOD, and 0.744 for 28-day mortality. The AUCs of PIRO were significantly greater than those of APACHE II and MEDS (P < 0.05) in predicting ICU admission and MOD.

Conclusions

The study indicates that PIRO is helpful for risk stratification and prognostic determinations in septic patients in the ED.
Appendix
Available only for authorised users
Literature
1.
Lagu T, Rothberg MB, Shieh MS, Pekow PS, Steingrub JS, Lindenauer PK: Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med 2012, 40: 754-761. 10.1097/CCM.0b013e318232db65CrossRefPubMed
2.
Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, Moreno R, Carlet J, Le Gall JR, Payen D, Sepsis Occurrence in Acutely Ill Patients Investigators: Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006, 34: 344-353. 10.1097/01.CCM.0000194725.48928.3ACrossRefPubMed
3.
Moerer O, Schmid A, Hofmann M, Herklotz A, Reinhart K, Werdan K, Schneider H, Burchardi H: Direct costs of severe sepsis in three German intensive care units based on retrospective electronic patient record analysis of resource use. Intensive Care Med 2002, 28: 1440-1446. 10.1007/s00134-002-1429-9CrossRefPubMed
4.
Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K: Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 2003, 31: 2332-2338. 10.1097/01.CCM.0000085141.75513.2BCrossRefPubMed
5.
Esteban A, Frutos-Vivar F, Ferguson ND, Peñuelas O, Lorente JA, Gordo F, Honrubia T, Algora A, Bustos A, García G, Diaz-Regañón IR, de Luna RR: Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med 2007, 35: 1284-1289. 10.1097/01.CCM.0000260960.94300.DECrossRefPubMed
6.
Iskander KN, Osuchowski MF, Stearns-Kurosawa DJ, Kurosawa S, Stepien D, Valentine C, Remick DG: Sepsis: multiple abnormalities, heterogeneous responses, and evolving understanding. Physiol Rev 2013, 93: 1247-1288. 10.1152/physrev.00037.2012PubMedCentralCrossRefPubMed
7.
Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW: Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med 2003, 31: 670-675. 10.1097/01.CCM.0000054867.01688.D1CrossRefPubMed
8.
9.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, International Sepsis Definitions Conference: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 2003, 29: 530-538. 10.1007/s00134-003-1662-xCrossRefPubMed
10.
Moreno RP, Metnitz B, Adler L, Hoechtl A, Bauer P, Metnitz PG: Sepsis mortality prediction based on predisposition, infection and response. Intensive Care Med 2008, 34: 496-504. 10.1007/s00134-007-0943-1CrossRefPubMed
11.
Rubulotta F, Marshall JC, Ramsay G, Nelson D, Levy M, Williams M: Predisposition, insult/infection, response, and organ dysfunction: a new model for staging severe sepsis. Crit Care Med 2009, 37: 1329-1335. 10.1097/CCM.0b013e31819d5db1CrossRefPubMed
12.
Howell MD, Talmor D, Schuetz P, Hunziker S, Jones AE, Shapiro NI: Proof of principle: the predisposition, infection, response, organ failure sepsis staging system. Crit Care Med 2011, 39: 322-327. 10.1097/CCM.0b013e3182037a8eCrossRefPubMed
13.
Granja C, Póvoa P, Lobo C, Teixeira-Pinto A, Carneiro A, Costa-Pereira A: The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach. PLoS One 2013, 8: e53885. 10.1371/journal.pone.0053885PubMedCentralCrossRefPubMed
14.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985, 13: 818-829. 10.1097/00003246-198510000-00009CrossRefPubMed
15.
Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE, Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR, Reinhart K, Kleinpell RM, Angus DC, Deutschman CS, Machado FR, Rubenfeld GD, Webb S, Beale RJ, Vincent JL, Moreno R, Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013, 39: 165-228. 10.1007/s00134-012-2769-8CrossRefPubMed
16.
Kushimoto S, Gando S, Saitoh D, Mayumi T, Ogura H, Fujishima S, Araki T, Ikeda H, Kotani J, Miki Y, Shiraishi SI, Suzuki K, Suzuki Y, Takeyama N, Takuma K, Tsuruta R, Yamaguchi Y, Yamashita N, Aikawa N: The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis. Crit Care 2013, 17: R271. 10.1186/cc13106PubMedCentralCrossRefPubMed
17.
Nguyen HB, Van Ginkel C, Batech M, Banta J, Corbett SW: Comparison of Predisposition, Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. J Crit Care 2012, 27: 362-369. 10.1016/j.jcrc.2011.08.013CrossRefPubMed
Metadata
Title
Risk stratification and prognostic performance of the predisposition, infection, response, and organ dysfunction (PIRO) scoring system in septic patients in the emergency department: a cohort study
Authors
Yun-Xia Chen
Chun-Sheng Li
Publication date
01-04-2014
Publisher
BioMed Central
Published in
Critical Care / Issue 2/2014
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13832

Other articles of this Issue 2/2014

Critical Care 2/2014 Go to the issue

Research

Decreased cardiac excitability secondary to reduction of sodium current may be a significant contributor to reduced contractility in a rat model of sepsis

Review

Stress ulceration: prevalence, pathology and association with adverse outcomes

Commentary

Leukodepleted versus nonleukodepleted red blood cell transfusion in septic patients: a microcirculatory vision

Research

Continuous venovenous hemofiltration versus extended daily hemofiltration in patients with septic acute kidney injury: a retrospective cohort study

Research

Prediction of mortality in adult patients with severe acute lung failure receiving veno-venous extracorporeal membrane oxygenation: a prospective observational study

Research

Coefficient of glucose variation is independently associated with mortality in critically ill patients receiving intravenous insulin