Sepsis mortality prediction based on predisposition, infection and response

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.

Biomarkers in sepsis at time zero: intensive care unit scores, plasma measurements and polymorphisms in Argentina

“…Moreover, a causative organism is never found in a sizeable minority of patients with the clinical presentation of sepsis [3]. In spite of significant advances in both the supportive care and the understanding of the molecular basis of sepsis, it is still the most common cause of death among patients, both in the intensive care unit (ICU) [3][4][5] and elsewhere [6]. It is possible that the perpetuation of the inflammatory response results in severe sepsis or septic shock [7][8].…”

Cellular and Molecular Markers of Outcome in Septic Shock

“…It includes Predisposition, Injury, Response and Organ Dysfunction . However, this approach remained up to now virtually conceptual and other research groups empirically developed in cohorts of patients a scale for predicting mortality in sepsis (Moreno et al 2008). Sepsis biomarkers may contribute to this model of classification.…”

Intelligent Management of Sepsis in the Intensive Care Unit

“…They include the already reviewed APACHE II score [1], as well as the SOFA score [2], and the LODS (Logistic Organ Dysfunction System) [47]. Two prognostic scores based on the PIRO model (predisposition, insult/infection, response and organ dysfunction) have also been recently proposed: the SAPS3 PIRO score ( [48]: AUC 0.77) and the PIRO score ( [49]: AUC 0.70).…”