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Advisor(s)
Abstract(s)
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.
Description
Keywords
Doença Crónica Infecções Comunitárias Adquiridas Infecção Hospitalar Mortalidade Bases de Dados Factuais Susceptibilidade a Doença Infecções por Bactérias Gram-Positivas Mortalidade Hospitalar Unidades de Cuidados Intensivos Sépsis Índice de Gravidade da Doença Insuficiência de Múltiplos Órgãos Choque Séptico Microbiologia Síndrome de Resposta Inflamatória Sistémica
Citation
Intensive Care Med. 2008 Mar;34(3):496-504