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Influence of Systemic Inflammatory Response Syndrome and Sepsis on Outcome of Critically Ill Infected Patients

Service de Santé Publique, Robert Debré Hospital and Intensive Care Unit, Saint-Louis Hospital, Paris 7 University, Paris, France; Intensive Care Unit, Henri Mondor Hospital, Paris XII University, Créteil, France; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel; Intensive Care Unit, San Raffaele Hospital, Milan, Italy; Medical Surgical Intensive Care Unit, University of Toronto, Toronto, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisbon, Portugal; Intensive Care Unit, University Hospital of Wales, Cardiff, United Kingdom; Zentrum Anaesthesiologie, Rettungs, und Intensivmedizin, University Hospital, Göttigen, Germany; and Critical Care Center, Parc Taulli University Hospital, Sabadell Hospital, Autonomous University of Barcelona, Barcelona, Spain

Correspondence and requests for reprints should be addressed to Corinne Alberti, M.D., Service de Santé Publique, 48 Boulevard Sérurier, 75019 Paris, France. E-mail: corinne.alberti{at}rdb.ap-hop-paris.fr

The clinical significance of the systemic inflammatory response in infected patients remains unclear. We examined risk factors for hospital mortality in 3,608 intensive care unit patients included in the European Sepsis Study. Patients were categorized as having infection without or with (i.e., sepsis) systemic inflammatory response, severe sepsis, and septic shock, on the first day of infection. Hospital mortality varied from 25 to 60% according to sepsis stage, but did not differ between the first two categories (hazard ratio, 0.94; p = 0.55), whereas there was a grading of severity from sepsis to severe sepsis (1.53, p < 10^-4) and septic shock (2.64, p < 10^-4). Within each stage, mortality was unaffected by the number of inflammatory response criteria. Prognostic factors identified by Cox regression included comorbid conditions, severity of acute illness and acute organ dysfunction, shock, nosocomial infection, and infection caused by aerobic gram-negative bacilli, enterobacteria, Staphylococcus aureus, and infection from a digestive or unknown source. We conclude that whereas the categorization of infection by the presence of organ dysfunction or shock has strong prognostic significance, infection and sepsis have similar outcomes, unaffected by the presence or number of inflammatory response criteria. Refinement of risk stratification of patients presenting with infection and no organ dysfunction is needed.

Key Words: infection • inflammatory response • mortality • risk factors • sepsis

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