Published ahead of print on April 17, 2003, doi:10.1164/rccm.200208-785OC
Am. J. Respir. Crit. Care Med., Volume 168, Number 1, July 2003, 77-84
A more recent version of this article appeared on July 1, 2003
Submitted on August 1, 2002
Accepted on April 13, 2003
THE INFLUENCE OF SIRS AND SEPSIS ON OUTCOME OF CRITICALLY ILL INFECTED PATIENTS
CORINNE ALBERTI1*, CHRISTIAN BRUN BUISSON2, SERGEY V GOODMAN3, DANIELA GUIDICI4, JOHN GRANTON5, RUI MORENO6, MARK SMITHIES7, OLIVER THOMAS8, ANTONIO ARTIGAS9, and JEAN ROGER LE GALL10
1 Service de Sante Publique, Robert Debre Hospital, Paris, France; Intensive Care Unit, Saint-Louis Hospital, Paris, France,
2 Intensive Care Unit, Henri Mondor Hospital, Creteil, France,
3 General Intensive Care Unit and Anesthiosiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel,
4 Intensive Care Unit, San Raffaele Hospital, Milan, Italy,
5 Medical Surgical Intensive Care Unit, University of Toronto, Toronto, Canada,
6 Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal,
7 Intensive Care Unit, University Hospital of Wales, Cardiff, Wales, United Kingdom,
8 Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, University Hospital, Gottingen, Germany,
9 Intensive Care Unit, Parc Taulli Hospital, Sabadell Barcelona, Spain,
10 Intensive Care Unit, Saint-Louis Hospital, Paris, France
* To whom correspondence should be addressed. 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 into infection without or with (ie., 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 were co-morbid conditions, severity of acute illness and acute organ dysfunction, shock, nosocomial infection and infection caused by aerobic gram negative bacilli, enterobacteriaceae, S.aureus, and infection from a digestive or unknown source. We conclude that while the categorization of infection by the presence of organ dysfunction or shock has strong prognostic significance, infection and sepsis have a similar outcome, 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: intensive care units, infection, sepsis, inflammatory response, mortality
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