Published ahead of print on November 5, 2004, doi:10.1164/rccm.200403-324OC Am. J. Respir. Crit. Care Med., Volume 171, Number 5, March 2005, 461-468 A more recent version of this article appeared on March 1, 2005
Submitted on March 15, 2004 Systemic Inflammatory Response and Progression to Severe Sepsis in Critically Ill Infected PatientsCorinne Alberti1,1 Clinical Epidemiology Unit, Hopital Robert Debre, Assistance Publique-Hopitaux de Paris, Universite Paris VII, Paris, France, 2 Medical Intensive Care Unit, Henri Mondor Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris XII, Creteil, France, 3 Department of Biostatistics, Saint-Louis Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris VII, Paris, France, 4 Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy, 5 General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel, 6 Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada, 7 Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisbon, Portugal, 8 Intensive Care Unit, Parc Taulli Hospital, Barcelona, Spain, 9 Intensive Care unit, Charing Cross Hospital, London, United Kingdom, 10 Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Luther-Universitat Halle-Wittenberg, Halle, Wittenberg, Germany, 11 Medical Intensive Care Unit, Hopital Saint-Louis, Assistance Publique-Hopitaux de Paris, Universite Paris VII, Paris, France * To whom correspondence should be addressed. E-mail: christian.brun-buisson{at}hmn.ap-hop-paris.fr.
Rationale: The systemic inflammatory response syndrome (SIRS) has low specificity to identify infected patients at risk of worsening to severe sepsis or shock. Objective: To examine the incidence of and risk factors for worsening sepsis in infected patients. Methods: A one-year inception cohort study in 28 intensive care units of patients (n=1,531) having a first episode of infection on admission or during the stay. Measurements and main results: The cumulative incidence of progression to severe sepsis or shock was 20% and 24% at days 10 and 30, respectively. Variables independently associated [hazard ratio, HR] with worsening sepsis included: temperature >38.2°C [1.6], heart rate >120/min [1.3], systolic blood pressure <110 mmHg [1.5], platelets <150.109/L [1.5], serum sodium >145 mMol/L [1.5], bilirubin >30 µMol/L [1.3], mechanical ventilation [1.5], and 5 variables characterizing infection (pneumonia [HR 1.5], peritonitis [1.5], primary bacteremia [1.8], and infection with gram positive cocci [1.3] or aerobic gram negative bacilli [1.4]). The 12 weighted variables were included in a score (RISSC, ranging from 0 to 49), summarized in 4 classes of 'low' (score 0 to 8) and 'moderate' (8.5 - 16) risk (9% and 17% probability of worsening, respectively), and of 'high' (16.5 to 24) and 'very high' (score > 24) risk (31% and 55% probability, respectively). Conclusions: One of four patients presenting with infection/sepsis worsen to severe sepsis or shock. A score estimating this risk, using objectively defined criteria for SIRS, could be used by physicians to stratify patients for clinical management and to test new interventions. Key words: sepsis, septic shock, intensive care units, risk prediction, multivariable models
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