Intensive Care Medicine

, Volume 34, Issue 3, pp 496–504 | Cite as

Sepsis mortality prediction based on predisposition, infection and response

  • Rui P. Moreno
  • Barbara Metnitz
  • Leopold Adler
  • Anette Hoechtl
  • Peter Bauer
  • Philipp G. H. Metnitz
  • SAPS 3 Investigators
Original

Abstract

Objective

To empirically test, based on a large multicenter, multinational database, whether a modified PIRO (predisposition, insult, response, and organ dysfunction) concept could be applied to predict mortality in patients with infection and sepsis.

Design

Substudy of a multicenter multinational cohort study (SAPS 3).

Patients

A total of 2,628 patients with signs of infection or sepsis who stayed in the ICU for > 48 h. Three boxes of variables were defined, according to the PIRO concept. Box 1 (Predisposition) contained information about the patient's condition before ICU admission. Box 2 (Injury) contained information about the infection at ICU admission. Box 3 (Response) was defined as the response to the infection, expressed as a Sequential Organ Failure Assessment score after 48 h.

Interventions

None.

Main measurements and results

Most of the infections were community acquired (59.6%); 32.5% were hospital acquired. The median age of the patients was 65 (50–75) years, and 41.1% were female. About 22% (n = 576) of the patients presented with infection only, 36.3% (n = 953) with signs of sepsis, 23.6% (n = 619) with severe sepsis, and 18.3% (n = 480) with septic shock. Hospital mortality was 40.6% overall, greater in those with septic shock (52.5%) than in those with infection (34.7%). Several factors related to predisposition, infection and response were associated with hospital mortality.

Conclusion

The proposed three-level system, by using objectively defined criteria for risk of mortality in sepsis, could be used by physicians to stratify patients at ICU admission or shortly thereafter, contributing to a better selection of management according to the risk of death.

Keywords

Intensive care unit Severity of illness Infection Sepsis PIRO Risk adjustment 

Supplementary material

134_2007_943_MOESM1_ESM.doc (3.2 mb)
Electronic Supplementary Material (DOC 3,3M)

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Rui P. Moreno
    • 1
  • Barbara Metnitz
    • 2
  • Leopold Adler
    • 3
  • Anette Hoechtl
    • 3
  • Peter Bauer
    • 2
  • Philipp G. H. Metnitz
    • 3
  • SAPS 3 Investigators
    • 1
  1. 1.Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos CapuchosCentro Hospitalar de Lisboa Central E.P.E.LisbonPortugal
  2. 2.Department of Medical StatisticsUniversity of ViennaViennaAustria
  3. 3.Department of Anesthesiology and General Intensive CareUniversity Hospital of ViennaViennaAustria

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