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Multicenter Study
. 2015 Oct 15;192(8):958-64.
doi: 10.1164/rccm.201502-0275OC.

Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients

Matthew M Churpek  1 , Frank J Zadravecz  1 , Christopher Winslow  2 , Michael D Howell  1 , Dana P Edelson  1
Affiliations
Multicenter Study

Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients

Matthew M Churpek et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Tools that screen inpatients for sepsis use the systemic inflammatory response syndrome (SIRS) criteria and organ dysfunctions, but most studies of these criteria were performed in intensive care unit or emergency room populations.

Objectives: To determine the incidence and prognostic value of SIRS and organ dysfunctions in a multicenter dataset of hospitalized ward patients.

Methods: Hospitalized ward patients at five hospitals from November 2008 to January 2013 were included. SIRS and organ system dysfunctions were defined using 2001 International Consensus criteria. Patient characteristics and in-hospital mortality were compared among patients meeting two or more SIRS criteria and by the presence or absence of organ system dysfunction.

Measurements and main results: A total of 269,951 patients were included in the study, after excluding 48 patients with missing discharge status. Forty-seven percent (n = 125,841) of the included patients met two or more SIRS criteria at least once during their ward stay. On ward admission, 39,105 (14.5%) patients met two or more SIRS criteria, and patients presenting with SIRS had higher in-hospital mortality than those without SIRS (4.3% vs. 1.2%; P < 0.001). Fourteen percent of patients (n = 36,767) had at least one organ dysfunction at ward admission, and those presenting with organ dysfunction had increased mortality compared with those without organ dysfunction (5.3% vs. 1.1%; P < 0.001).

Conclusions: Almost half of patients hospitalized on the wards developed SIRS at least once during their ward stay. Our findings suggest that screening ward patients using SIRS criteria for identifying those with sepsis would be impractical.

Keywords: multiple organ failure; organ dysfunction scores; sepsis; systemic inflammatory response syndrome.

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Figures

Figure 1.
Figure 1.
Cumulative proportion of patients remaining on the wards who met systemic inflammatory response syndrome (SIRS) criteria at least once during their ward stay before each time point.
Figure 2.
Figure 2.
The association between in-hospital mortality and systemic inflammatory response syndrome (SIRS) criteria met at ward admission. HR = heart rate; RR = respiratory rate; Temp = temperature; WBC = white blood cell count.
Figure 3.
Figure 3.
In-hospital mortality and the number of organ system dysfunctions at ward admission and 24 hours on the ward.
Figure 4.
Figure 4.
In-hospital mortality and the change in organ system dysfunction from ward admission to 24 hours after admission.
See this image and copyright information in PMC

Comment in

  • Identification of Sepsis among Ward Patients.
    Smyth MA, Daniels R, Perkins GD. Smyth MA, et al. Am J Respir Crit Care Med. 2015 Oct 15;192(8):910-1. doi: 10.1164/rccm.201507-1395ED. Am J Respir Crit Care Med. 2015. PMID: 26469838 No abstract available.

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