Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: Incidence, morbidities and outcomes in surgical ICU patients
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To determine the incidence of systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis in surgical ICU patients and define patient characteristics associated with their acquisition and outcome.
One-month prospective study of critically ill patients with a 28 day in-hospital follow up.
Surgical intensive care unit (SICU) at a tertiary care institution.
All patients (n=170) admitted to the SICU between April 1 and April 30, 1992 were prospectively followed for 28 days. Daily surveillance was performed by two dedicated, specifically-trained research nurses. Medical and nursing chart reviews were performed, and follow up information at six and twelve months was obtained.
The in-hospital surveillance represented 2246 patient-days, including 658 ICU patient-days. Overall, 158 patients (93%) had SIRS for an incidence of 542 episodes/1000 patients-days. The incidence of SIRS in the ICU was even higher (840 episodes/1000 patients-days). A total of 83 patients (49%) had sepsis; among them 28 developed severe sepsis. Importantly, 13 patients had severe sepsis after discharge from the ICU. Patient groups were comparable with respect to age, sex ratio, and type of surgery performed. Apach II score on admission to the ICU and ASA score at time of surgery were significantly higher (p<0.05) only for patients who subsequently developed severe sepsis. The crude mortality at 28 days was 8.2% (14/170); it markedly differed among patient groups: 6% for those with SIRS vs. 35% for patients with severe sepsis. Patients with sepsis and severe sepsis had a longer mean length of ICU stay (2.1±0.2 and 7.5±1.5, respectively) than those with SIRS (1.45±0.1) or control patients (1.16±0.1). Total length of hospital stay also markedly differed among groups (35±9 (severe sepsis), 24±2 (sepsis), 11±0.8 (SIRS), and 9±0.1 (controls, respectively).
Almost everyone in the SICU had SIRS. Therefore, because of its poor specificity, SIRS was not helpful predicting severe sepsis and septic shock. Patients who developed sepsis or severe sepsis had higher crude mortality and length of stay than those who did not. Studies designed to identify those who develop complications of SIRS would be very useful.
- Pittet, D, Herwaldt, LA, Massanari, RM The intensive care unit. In: Brachman, PS, Bennett, JV eds. (1992) Hospital infections. Little, Brown and Company, Boston, MA, pp. 405-439
- Donowitz, LG (1986) High risk of nosocomial infection in the pediatric critical care patient. Crit Care Med 14: pp. 26-28
- Daschner, FD, Frey, P, Wolff, G, Baumann, PC, Suter, P (1982) Nosocomial infections in intensive care wards: a multicenter prospective study. Intensive Care Med 8: pp. 5-9
- Pittet, D, Tarara, D, Wenzel, RP (1994) Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 271: pp. 1598-1601
- Duggan, JM, Oldfield, GS, Ghosh, HK (1985) Septicaemia as a hospital hazard. J Hosp Infect 6: pp. 406-412
- Bone, RC, Fischer, CJ, Clemmer, TP, Slotman, GJ, Metz, CA, Balk, RA (1989) Sepsis syndrome: a valid clinical entity. Crit Care Med 17: pp. 389-393
- Ziegler, EJ, Fisher, CJ, Sprung, CL, Straube, RC, Sadoff, JC, Foulke, GE, Wortel, CH, Fink, MP, Dellinger, RP, Teng, NNH, Allen, IE, Berger, HJ, Knatterud, GL, LoBuglio, AF, Smith, CR (1991) Treatment of gram-negative bacteremia and septic shock with HA-1 A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. N Engl J Med 324: pp. 429-436
- Greenman, RL, Schein, RMH, Martin, MA, Wenzel, RP, MacIntyre, NR, Emmanuel, G, Chmel, H, Kohler, RB, McCarthy, M, Plouffe, J, Russell, JA (1991) A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. JAMA 266: pp. 1097-1102
- Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: pp. 864-874
- Owens, WD, Felts, JA, Spitznagel, EL (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49: pp. 239-243
- Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE (1985) Apache II: a severity of disease classification system. Crit Care Med 13: pp. 818-829
- McCabe, WR, Jackson, GG (1962) Gram-negative bacteremia. I. Etiology and ecology. Arch Intern Med 110: pp. 847-855
- Hebert, PC, Drummond, AJ, Singer, JS, Bernard, GR, Russel, JA (1993) A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome. Chest 104: pp. 230-235
- Bone, RC (1992) Toward an epidemiology and natural history of SIRS (systemic inflammatory response syndrome). JAMA 268: pp. 3452-3455
- Bone, RC, Fisher, CJ, Clemmer, TP (1987) A controlled clinical trial of high dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 317: pp. 653-658
- Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic shock. N Engl J Med 317: pp. 659-665
- Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: Incidence, morbidities and outcomes in surgical ICU patients
Intensive Care Medicine
Volume 21, Issue 4 , pp 302-309
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Critically ill
- Septic shock
- Systemic inflammatory response syndrome
- Industry Sectors
- Author Affiliations
- 1. Division of General Medicine, Clinical Epidemiology and Health Services Research, University of Iowa College of Medicine, Iowa City, USA
- 3. Department of Internal Medicine, Division of Medical Biostatistics, Department of Preventive Medicine, University of Iowa College of Medicine, Iowa City, USA
- 5. Division of Intensive Care, Department of Anesthesiology, University of Iowa College of Medicine, Iowa City, USA