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Sepsis mortality prediction based on predisposition, infection and response

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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.

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Acknowledgements

Statistical analysis was supported by a grant from the Fund of the Austrian National Bank, Project # 10995 ONB. Our thanks go to the participants from all over the world who dedicated a significant amount of their time and effort to this project, proving that it is still possible to conduct a worldwide academic study. The complete list of participants can be found in Appendix D of the ESM.

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Authors and Affiliations

  1. Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central E.P.E., 1150-069, Lisbon, Portugal

    Rui P. Moreno

  2. Department of Medical Statistics, University of Vienna, Vienna, Austria

    Barbara Metnitz & Peter Bauer

  3. Department of Anesthesiology and General Intensive Care, University Hospital of Vienna, Vienna, Austria

    Leopold Adler, Anette Hoechtl & Philipp G. H. Metnitz

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  1. Rui P. Moreno
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  2. Barbara Metnitz
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  3. Leopold Adler
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  5. Peter Bauer
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  6. Philipp G. H. Metnitz
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SAPS 3 Investigators

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Correspondence to Rui P. Moreno.

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Moreno, R.P., Metnitz, B., Adler, L. et al. Sepsis mortality prediction based on predisposition, infection and response. Intensive Care Med 34, 496–504 (2008). https://doi.org/10.1007/s00134-007-0943-1

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  • DOI: https://doi.org/10.1007/s00134-007-0943-1

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