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Does severe non-infectious SIRS differ from severe sepsis?

Results from a multi-centre Australian and New Zealand intensive care unit study

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Abstract

Objective

To compare the time course of organ dysfunction/failure, mortality and cause of death in patients with severe sepsis (SS) and patients with severe non-infectious systemic inflammatory response syndrome (SNISIRS).

Design

Secondary analysis of a multi-centre inception cohort study.

Setting

Twenty-three multidisciplinary intensive care units (ICUs) in Australia and New Zealand.

Patients and participants

3,543 ICU admissions ≥48 h or <48 h if SIRS and organ dysfunction present.

Interventions

None.

Measurements and results

ICU prevalence of SS and SNISIRS was 20% (707/3,543) and 28% (980/3,543), respectively. ICU mortality was similar in patients with SNISIRS and with SS (25 vs. 27%, P = 0.40). Central nervous system (CNS) failure occurred more frequently in patients with SNISIRS (33 vs. 22%, P < 0.001) and resulted in death more commonly than in SS (relative risk = 1.6, 95% confidence interval 1.4–1.7, P < 0.001). The time to peak organ dysfunction (0.67 vs. 0.91 days, P = 0.004), overall episode length (3.6 vs. 5.6 days, P < 0.001) and ICU stay (geometric mean: 4.1 vs. 5.8 days, P < 0.001) were significantly shorter in patients with SNISIRS.

Conclusions

Whilst SNISIRS and SS have similarities, including their crude mortality rate, important differences exist. SNISIRS is more common on admission to the ICU, and is more commonly coupled with CNS dysfunction and death from neurological failure.

Descriptors

SIRS/sepsis: clinical studies.

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Acknowledgments

We wish to acknowledge the medical and nursing staff at the 21 participating hospitals that were associated with this research. Preparation of this manuscript was assisted by a grant from the Royal Brisbane and Women’s Hospital Research Foundation (Dr. Dulhunty).

Author information

Authors and Affiliations

  1. Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, and Burns, Trauma and Critical Care Research Centre, University of Queensland, Herston, QLD, 4029, Australia

    Joel M. Dulhunty & Jeffrey Lipman

  2. ANZICS Clinical Trials Group, 10 Ievers Terrace, Carlton, VIC, 3053, Australia

    Jeffrey Lipman & Simon Finfer

  3. Royal North Shore Hospital and The George Institute for International Health, University of Sydney, Sydney, Australia

    Simon Finfer

Authors
  1. Joel M. Dulhunty
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  2. Jeffrey Lipman
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  3. Simon Finfer
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Consortia

the Sepsis Study Investigators for the ANZICS Clinical Trials Group

Corresponding author

Correspondence to Joel M. Dulhunty.

Appendix: Sepsis Study Investigators and affiliations

Appendix: Sepsis Study Investigators and affiliations

Simon Finfer, Royal North Shore Hospital, NSW, Australia

Rinaldo Bellomo, Austin Hospital, VIC, Australia

Andrew Bersten, Flinders Medical Centre, SA, Australia

Andrew Davies, Alfred Hospital, VIC, Australia

Geoffrey Dobb, Royal Perth Hospital, WA, Australia

Arthas Flabouris, Liverpool Hospital, NSW, Australia

Craig French, Western Hospital, VIC, Australia

David Green, Geelong Hospital, VIC, Australia

Stuart Green, Gold Coast Hospital, QLD, Australia

Felicity Hawker, Cabrini Hospital, VIC, Australia

Seton Henderson, Christchurch Hospital, New Zealand

Tamara Hunt, Flinders Medical Centre, SA, Australia

Chris Joyce, Princess Alexandra Hospital, QLD, Australia

Anthony Limpus, Princess Alexandra Hospital, QLD, Australia

Jeffrey Lipman, Royal Brisbane and Women’s Hospital, QLD, Australia

Colin MacArthur, Auckland Hospital, New Zealand

Eileen MacKenzie, Royal Perth Hospital, WA, Australia

Maria Magnaye, Royal North Shore Hospital, NSW, Australia

Imogen Mitchell, Royal Prince Alfred Hospital, NSW, Australia

Gordon Morris, Royal Perth Hospital, WA, Australia

John Myburgh, St. George Hospital, NSW, Australia

Lynette Newby, Auckland Hospital, New Zealand

James Nicholls, Canberra Hospital, ACT, Australia

Michael O’Leary, St. George Hospital, NSW, Australia

Graham Reece, Blacktown Hospital, NSW, Australia

Brent Richards, Gold Coast Hospital, QLD, Australia

Brigitte Roberts, Sir Charles Gairdner Hospital, WA, Australia

Tom Solano, Hornsby Hospital, NSW, Australia

Lorisa Soloveychik, Cabrini Hospital, VIC, Australia

Vladimir Szachin, Royal North Shore Hospital, NSW, Australia

Andrew Turner, Royal Hobart Hospital, TAS, Australia

Vernon Van Heerden, Sir Charles Gairdner Hospital, WA, Australia

Donna Wise, Austin Hospital, VIC, Australia

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Dulhunty, J.M., Lipman, J., Finfer, S. et al. Does severe non-infectious SIRS differ from severe sepsis?. Intensive Care Med 34, 1654–1661 (2008). https://doi.org/10.1007/s00134-008-1160-2

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  • DOI: https://doi.org/10.1007/s00134-008-1160-2

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