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Am J Respir Crit Care Med. 2005 Mar 1;171(5):461-8. Epub 2004 Nov 5.

Systemic inflammatory response and progression to severe sepsis in critically ill infected patients.

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1
Clinical Epidemiology Unit, Hôpital Robert Debré, Paris, France.

Abstract

RATIONALE:

The systemic inflammatory response syndrome has low specificity to identify infected patients at risk of worsening to severe sepsis or shock.

OBJECTIVE:

To examine the incidence of and risk factors for worsening sepsis in infected patients.

METHODS:

A 1-year inception cohort study in 28 intensive care units of patients (n = 1,531) having a first episode of infection on admission or during the stay.

MEASUREMENTS AND MAIN RESULTS:

The cumulative incidence of progression to severe sepsis or shock was 20% and 24% at Days 10 and 30, respectively. Variables independently associated (hazard ratio [HR]) with worsening sepsis included: temperature higher than 38.2 degrees C (1.6), heart rate greater than 120/minute (1.3), systolic blood pressure higher than 110 mm Hg (1.5), platelets higher than 150 x 109/L (1.5), serum sodium higher than 145 mmol/L (1.5), bilirubin higher than 30 mumol/L (1.3), mechanical ventilation (1.5), and five variables characterizing infection (pneumonia [HR 1.5], peritonitis [1.5], primary bacteremia [1.8], and infection with gram-positive cocci [1.3] or aerobic gram-negative bacilli [1.4]). The 12 weighted variables were included in a score (Risk of Infection to Severe Sepsis and Shock Score, range 0-49), summarized in four classes of "low" (score 0-8) and "moderate" (8.5-16) risk (9% and 17% probability of worsening, respectively), and of "high" (16.5-24) and "very high" (score > 24) risk (31% and 55% probability, respectively).

CONCLUSIONS:

One of four patients presenting with infection/sepsis worsen to severe sepsis or shock. A score estimating this risk, using objectively defined criteria for systemic inflammatory response syndrome, could be used by physicians to stratify patients for clinical management and to test new interventions.

PMID:
15531752
DOI:
10.1164/rccm.200403-324OC
[Indexed for MEDLINE]
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