Modulators of systemic inflammatory response syndrome presence in patients admitted to intensive care units with acute infection: a Bayesian network approach

  • Fernando G. ZampieriEmail author
  • Fernanda J. Aguiar
  • Fernando A. Bozza
  • Jorge I. F. Salluh
  • Marcio Soares
  • for the ORCHESTRA Study Investigators

Dear Editor,

Several factors may modulate the presence of systemic inflammatory response syndrome (SIRS) in patients with infection [1], which are expected to interact. Establishing a direct causal pathway among them may be challenging, and traditional statistical modeling may fail to correct (or overcorrect) for confounders. We hypothesized that some of these factors, namely age, sex, ECOG performance status (PS) [2], source of infection and presence of diabetes and active cancer, could modulate the presence of SIRS at intensive care unit (ICU) admission. We expected that increasing age, diabetes, female gender, worse performance status and cancer would be associated with lower SIRS probability and that some specific infection sources (such as bloodstream infection) would be associated with higher SIRS probability.

Of 129,680 patients, 27,438 (21.1%) admitted to 93 ICUs because of infection between 2014 and 2015 were elected for this analysis [2]. Mean age was 67 ± 20.4 years and...


Author contributions

FGZ, FJA and MS participated in study conception, data interpretation and drafting of the manuscript. FGZ and FJA performed the statistical analysis and produced the figures. FGZ, FAB, JIFS and MS led data collection and cleaning. All authors revised the manuscript for important intellectual content and approved the final version of the manuscript.


This study was supported by the National Council for Scientific and Technological Development (CNPq), Carlos Chagas Filho Foundation for Research Support of the State of Rio de Janeiro (FAPERJ) and by departmental funds from the D’Or Institute for Research and Education.

Compliance with ethical standards

Conflicts of interest

JIFS and MS are founders and proprietors of Epimed®, a cloud-based solution for ICU performance measurements and benchmarking. The other authors report no conflicts of interest to declare.

Ethical approval

The local ethics committee at the D’Or Institute for Research and Education (Approval Number 334.835) and the Brazilian National Ethics Committee (CAAE 19687113.8.1001.5249) approved the ORCHESTRA study and analyses.

Supplementary material

134_2019_5595_MOESM1_ESM.docx (174 kb)
Supplementary material 1 (DOCX 173 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Research InstituteHCor-Hospital do CoraçãoSão PauloBrazil
  2. 2.Hospital Alemão Oswaldo CruzSão PauloBrazil
  3. 3.Intensive Care UnitHospital Sírio-LibanêsSão PauloBrazil
  4. 4.D’OrInstitute for Research and EducationRio de JaneiroBrazil

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