Systemic inflammatory response syndrome (SIRS) in Mosul: Clinical characteristics and predictors of poor outcome

Abstract

Objectives: Systemic inflammatory response syndrome is one of the most important causes of intensive care unit (ICU) morbidity and mortality worldwide. The aim of this study is to explore the spectrum of diseases responsible for SIRS admission in Mosul, and to identify the mortality rate and the factors associated with poor outcome. Methods: Fifty patients with sepsis or non-infective SIRS were studied during the period from June 1 st to November 30 th 2009. Patients were collected from the medical ICU and the general medical wards in Ibn-Sina Teaching Hospital in Mosul,. Acute physiology and chronic health evaluation II (APACHE II) score was utilized to assess the severity of illness on admission. The patients included in the study received the standard medical care according to their condition, and were followed to delineate the cause of their illness, the percentage of microbiological confirmation, the duration of hospital stay, the mortality rate and the factors that influence their outcome. Results: Sepsis represented 86% of cases of SIRS, of which 82% of them were caused by community acquired infections. Pneumonia was responsible for 48.8% of sepsis cases, followed by acute pyelonephritis and intra-abdominal infection. Sepsis was microbiologically confirmed in 44.2% of patients, and blood culture was positive in 18.6% of patients. Impaired consciousness, anaemia, hyperglycaemia and high blood urea were associated with excess mortality rate; while positive blood culture and hypoalbuminaemia correlated with high APACHE II score. The overall mortality rate was 44%. Patients with severe sepsis had a mortality rate of 55.2%. Conclusion: SIRS is an important cause of hospital admission in Mosul, with associated high mortality rate. ICU admission should be seriously considered for patients with certain risk factors that predict poor outcome.