Met Systemic Inflammatory Response Syndrome Criteria Research Articles

Cardiopulmonary Failure Requiring ECMO Bypass Resulting from Leukemia Cell Lysis in a Patient with Childhood Acute Myelomonocytic Leukemia.

Background. Childhood AML patients are at increased risk for early fatal pulmonary complications. Pulmonary leukostasis and systemic inflammatory response syndrome (SIRS) following leukemia cell lysis are the likely etiologies. Observation. Soon after initiation of AML chemotherapy, an 18-month-old female who met SIRS criteria sustained cardiopulmonary failure requiring ECMO support. Upon recovery, the patient went on to complete therapy and remains in remission without permanent neurologic or cardiac sequelae. Conclusion. Cytokine release syndrome from rapid cell lysis was the likely cause as infectious workup failed to reveal a definitive etiology and drug hypersensitivity testing to the chemotherapy agents was negative.

MP18-14 IS ONE WEEK ANTIBIOTIC PROPHYLAXIS NECESSARY BEFORE PERCUTANEOUS NEPHROLITHOTOMY? A RETROSPECTIVE REVIEW OF 7 VS 2 DAY THERAPY

INTRODUCTION AND OBJECTIVES: Urosepsis is a complication of percutaneous nephrolithotomy (PCNL) that can occur despite sterile urine and studies have suggested that one week of prophylactic antibiotic therapy can reduce the risk of systemic inflammatory response syndrome (SIRS) and infectious complications in high risk patients with sterile urine. Approximately one-third of upper urinary tract stones harbor virulent microorganisms despite antibiotic therapy. Since antibiotic levels reach a steady state after only 48 hours, our goal was to determine whether antimicrobial therapy of 2 days is as effective as 7 days in preventing SIRS and infectious complications after PCNL. METHODS: We retrospectively reviewed 135 consecutive PCNLs performed by a single surgeon at one institution between January 2012 and October 2013. Preoperative urine cultures were obtained on all patients and positive cultures treated appropriately. Patients with sterile urine were divided into low or high risk (previous UTI, dilated pelvicaliceal systems or stones iÝ 20mm). Patients in the high risk group were treated with either 7 or 2 days antibiotics prior to PCNL. Antibiotic related adverse events and infectious outcomes were recorded for all patients and evaluated using univariate cumulative logit regression analysis. RESULTS: Of the 135 patients, 83 (61.5%) had sterile urine of which 59 (43.7%) met high risk criteria and were treated with either 7 days (31 pts) or 2 days (28 pts) preoperative antibiotics. Both groups were similar in age, gender, and duration of surgery. Comparing 7 vs 2 days treatment there was plevicalyectasis in 11 (35.5%) vs 8pts (28.6%), stone >20mm in 26 (83.8%) vs 23 (82.1%), and previous UTI in 15 (48.4%) vs 11pts (39.3%). There were 15 (25.4%) positive stone cultures overall, (10 pts in the 7 day group and 5 in the 2 day group). No patients in either group had a fever (temp >38.5), met SIRS criteria or developed a postoperative infection or sepsis after PCNL. There were no antibiotic associated complications. CONCLUSIONS: Prophylactic antibiotics for either 7 or 2 days prevented fever, SIRS and infectious complications in our high-risk patients with sterile urine before PCNL. This finding should be confirmed in a larger prospective trial. In the meantime, our results suggest that 2-days prophylactic antibiotics are equivalent to 7-days in reducing the risk of infectious complications after PCNL.

The clinical characteristics and outcomes of patients with human granulocytic anaplasmosis in China

The incidence of human granulocytic anaplasmosis (HGA), a tick-borne disease caused by the obligate intracellular bacterium Anaplasma phagocytophilum, has increased across the world. However, information on HGA is lacking in China. The purpose of this study was to investigate the clinical features and outcomes of HGA patients in China. A total of 83 patients with HGA from the provinces of Hubei and Henan in China, who were admitted to Union Hospital between March 2009 and September 2010, were included in this study. We investigated the epidemiology, clinical features, laboratory markers, and therapeutic effects in these patients. We also analyzed life-threatening complications such as systemic inflammatory response syndrome (SIRS)/multiple organ dysfunction syndrome (MODS) following HGA and assessed the risk factors for a poor clinical outcome. In our study, an HGA outbreak peak was observed for the months May to August. The highest age-specific incidence occurred among the group of patients aged 50-59 years. With regard to patient occupation and pathological origin, we found that 73 of the 83 patients with HGA had a peasant occupation. With respect to symptoms, 45 patients had no complications and 38 patients diagnosed with HGA met SIRS criteria, of whom 25 rapidly developed MODS. The mortality for the entire cohort was 26.5%. The factors predictive of patients developing MODS and an adverse outcome were advanced age, disturbance of consciousness, highly elevated lactate dehydrogenase, creatinine, and aspartate aminotransferase levels, and the presence of SIRS. Moreover, MODS was found to be an independent predictor of death. In China, HGA patients had severe clinical symptoms and high rates of complications and mortality. These findings may provide useful information so that physicians will be on the alert for severe complications after a diagnosis of HGA; they will also be useful for optimizing supportive care for HGA-related critical illness. Prompt treatment and close monitoring of severe complications such as SIRS and MODS are of great importance in saving patient lives.

Existing models fail to predict sepsis in an obstetric population with intrauterine infection

Multiple scoring systems exist to identify inpatients who are at risk for clinical deterioration. None of these systems have been evaluated in an obstetric population. We examined the Systemic Inflammatory Response syndrome (SIRS) and Modified Early Warning score (MEWS) criteria in pregnant women with chorioamnionitis. This was an 18-month retrospective analysis of patients with chorioamnionitis. SIRS and MEWS scores were calculated; clinical outcomes were ascertained, and test characteristics were calculated for the primary outcome of sepsis, intensive care unit transfer, or death. Nine hundred thirteen women with chorioamnionitis were identified. Five women experienced sepsis; there was 1 death. Five hundred seventy-five of the 913 women (63%) met SIRS criteria (95% confidence interval, 59.8-66.2%; positive predictive value, 0.9%). Ninety-two of the 913 women (10.3%) had a MEWS score of ≥ 5 (95% confidence interval, 8.3-12.2%; positive predictive value, 0.05%). SIRS and MEWS criteria do not identify accurately patients who are at risk for intensive care unit transfer, sepsis, or death among pregnant women with intrauterine infection and should not be used in an obstetric setting.

The systemic inflammatory response syndrome in cirrhotic patients: Relationship with their in-hospital outcome

Some evidence suggests that the systemic inflammatory response syndrome (SIRS) contributes to the poor outcome of cirrhotic patients. We studied 141 cirrhotic patients consecutively admitted to a tertiary referral centre assessing prevalence of SIRS and its relationship with in-hospital outcome. Presence of SIRS was assessed on admission and during hospital stay. Main clinical outcomes were death and development of portal hypertension-related complications. Thirty-nine patients met SIRS criteria. SIRS was present on admission in 20 of 141 patients (14.1%), whereas it occurred during hospital stay in 19 of 121 (15.7%). SIRS was correlated with bacterial infection at admission (p=0.02), jaundice (p=0.011), high serum creatinine levels (p=0.04), high serum bilirubin levels (p=0.002), high international normalized ratio (p=0.046), high model of end-stage liver disease (MELD) score (p=0.001), and high SOFA score (p=0.003). During a follow-up of 14+/-8 days, 16 patients died (11%), 7 developed portal hypertension-related bleeding (5%), 16 hepatic encephalopathy (11%), and 5 hepatorenal syndrome type-1 (3.5%). SIRS was correlated both to death (p<0.001) and to portal hypertension-related complications (p<0.001). On multivariate analysis, SIRS and MELD were independently associated with death. SIRS frequently occurs in patients with advanced cirrhosis and is associated with a poor outcome.

The effects of leucodepletion in patients with the Systemic Inflammatory Response Syndrome (SIRS)

Cardiopulmonary bypass may generate SIRS and subsequent multiple organ failure. Tissue damage is likely to arise from the untoward activity of infiltrating blood polymorphonuclear cells (PMNs) interacting with the endothelium of blood vessels to increase vascular permeability. The aim of this study was to determine the effect of leucodepletion in these patients, and to investigate whether leucofiltration of blood from SIRS patients modified the binding of PMNs to cultured endothelial cells. Twenty-four patients who met SIRS criteria at 36 h after cardiac surgery were equally randomized to leucofiltration (LF) or control therapy. LF patients (nine male; APACHE II 21 ± 2; age 62 ± 10) received 1 h filtration cycles using a venovenous extracorporeal circuit at 200 ml min−1, repeated at 12 h intervals. Control patients (12 male; APACHE II 21 ± 2; age 63 ± 9) received standard post-operative care. Hypoxaemia index (PaO2/FIO2) was calculated up to 96 h from the onset of treatment. Blood from patients with SIRS was also subjected to leucofiltration in a laboratory-based extracorporeal circuit and the PMNs examined for their ability to bind to monolayers of endothelial cells derived from human umbilical veins. The results are expressed as mean values ± SD. Patients undergoing leucofiltration received an average 4.2 cycles (range 1–8). After 15 min the total leucocyte count fell from 16.2 ± 5.3 to 10.4 ± 3.3, the PMNs from 14.4 ± 5.2 to 8.3 ± 4.2, and platelets from 127 ± 87 to 117 ± 82×109 litre. All of the counts returned to baseline values by the end of the 60 min filtration period. The average length of stay for the LF and control group was 206 ± 118 and 214 ± 196 h respectively. Four LF patients and three control patients died before hospital discharge. At 96 h, 2-way ANOVA showed that the hypoxaemia index was significantly improved in the LF group compared with control patients (P In conclusion, the present study demonstrates that leucofiltration safely removes circulating PMNs from patients with SIRS following cardiopulmonary bypass. The removal from SIRS blood of PMNs that adhere to endothelium could reduce the sequelae of events that underlie organ failure in this disorder, particularly as lung function of SIRS patients is improved by leucofiltration treatment.

The natural history of the systemic inflammatory response syndrome and the evaluation of SIRS criteria as a predictor of severity in patients hospitalized through emergency services.

Based on the concept of the systemic inflammatory response syndrome (SIRS), a one-year retrospective study was carried out among a total of 2389 patients transported to the emergency room by ambulance. With respect to 351 patients who had all data necessary for evaluating SIRS criteria in 369 hospitalized patients, 200 met SIRS criteria within 24 hours of admission (24h-SIRS). The mortality rate for 24h-SIRS patients was significantly higher than that of non-SIRS patients. The mortality rate for 24h-SIRS patients increased sequentially as more SIRS criteria were met. In 235 patients who met SIRS criteria during hospitalization (overall-SIRS), 108 had sepsis. Of these, 60 developed severe sepsis, and 50 developed septic shock. The mortality rate for patients who had 3 or more consecutive days of SIRS was significantly higher than that for those with less than 3 consecutive SIRS days. Among 153 patients who had all data necessary for APACHEIII scoring within 24 hours of admission, the mortality rate for SIRS patients whose APACHEIII score was 50 or higher was 40.7%, significantly higher than that of other patients. In conclusion, SIRS criteria were demonstrated to be useful as indicators of severity and for predicting outcome in patients hospitalized through emergency services. Patients who met the following criteria were found to be a high-risk population among hospitalized emergency patients with SIRS: (1) Those who had three or more consecutive days of SIRS. (2) Those whose APACHEIII score was 50 or higher.

Evaluation of Systemic Inflammatory Response Syndrome Criteria as a Predictor of Mortality in Emergency Patients Transported by Ambulance.

Based on the concept of the systemic inflammatory response syndrome (SIRS), a one year retrospective study was carried out to examine SIRS criteria as a simple and rapid predictor of outcome for emergency patients. Among a total of 2,180 patients transported to the emergency room by ambulance, 318 (14.8%) had primary SIRS and 389 (17.8%) met SIRS criteria at some point during the entire treatment period. The admission rate for primary SIRS increased sequentially as more SIRS criteria were met, rising from 15.4% in non-SIRS to 100% when all four criteria were met. The mortality of primary SIRS also increased sequentially as more SIRS criteria were met, rising from 1.4% in non-SIRS to 35.3% when all four criteria were met. Furthermore, heart rate, C-reactive protein and platelet count were considered to be potentially useful new criteria for a group of SIRS patients with a high risk of mortality (high-risk SIRS), based on a comparison of variables between SIRS patients who died and SIRS patients who survived. The mortality associated with primary SIRS increased sequentially as more high-risk SIRS criteria were met, rising from 7.6% when none were met to 50.0% when two criteria were met. Considering the high specificity of primary SIRS for admission (89.5%) and mortality (86.8%), SIRS criteria have clinical and prognostic importance in the management of emergency patients. Given the high mortality (29.9%), the new high-risk SIRS criteria may also be useful as entry criteria for clinical trials of innovative therapies for patients with SIRS.

Evaluation of Definitions of Sepsis

Evaluation of Definitions of Sepsis

Points from Letters: The Paediatrician and the Future

<h3>Objective</h3> To compare the daily practice of two emergency departments (ED) in the Netherlands, where systemic inflammatory response syndrome (SIRS) criteria and quick Sequential Organ Failure Assessment (qSOFA) score are used differently as screening tools for culture-positive sepsis. <h3>Design</h3> A prospective cross-sectional multicentre study. <h3>Setting</h3> Two EDs at two European clinical teaching hospitals in the Netherlands. <h3>Participants</h3> 760 patients with suspected infection who met SIRS criteria or had a qualifying qSOFA score who were treated at two EDs in the Netherlands from 1 January to 1 March 2018 were included. <h3>Methods</h3> SIRS criteria and qSOFA score were calculated for each patient. The first hospital treated the patients who met SIRS criteria following the worldwide Surviving Sepsis Campaign protocol. At the second hospital, only patients who met the qualifying qSOFA score received this treatment. Therefore, patients could be divided into five groups: (1) SIRS+, qSOFA−, not treated according to protocol (reference group); (2) SIRS+, qSOFA−, treated according to protocol; (3) SIRS+, qSOFA+, treated according to protocol; (4) SIRS−, qSOFA+, not treated according to protocol; (5) SIRS−, qSOFA+, treated according to protocol. <h3>Primary and secondary outcome measures</h3> To prove culture-positive sepsis was present, cultures were used as the primary outcome. Secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission. <h3>Results</h3> 98.9% met SIRS criteria and 11.7% met qSOFA score. Positive predictive values of SIRS criteria and qSOFA score were 41.2% (95% CI 37.4% to 45.2%) and 48.1% (95% CI 37.4% to 58.9%), respectively. HRs were 0.79 (95% CI 0.40 to 1.56, p=0.500), 3.42 (95% CI 1.82 to 6.44, p&lt;0.001), 18.94 (95% CI 2.48 to 144.89, p=0.005) and 4.97 (95% CI 1.44 to 17.16, p=0.011) for groups 2–5, respectively. <h3>Conclusion</h3> qSOFA score performed as well as SIRS criteria for identifying culture-positive sepsis and performed significantly better for predicting in-hospital mortality and ICU admission. This study shows that SIRS criteria are no longer necessary and recommends qSOFA score as the standard for identifying culture-positive sepsis in the ED. <h3>Trial registration number</h3> NL8315.

Physical Therapy in Mental Disorder

<h3>Objective</h3> To compare the daily practice of two emergency departments (ED) in the Netherlands, where systemic inflammatory response syndrome (SIRS) criteria and quick Sequential Organ Failure Assessment (qSOFA) score are used differently as screening tools for culture-positive sepsis. <h3>Design</h3> A prospective cross-sectional multicentre study. <h3>Setting</h3> Two EDs at two European clinical teaching hospitals in the Netherlands. <h3>Participants</h3> 760 patients with suspected infection who met SIRS criteria or had a qualifying qSOFA score who were treated at two EDs in the Netherlands from 1 January to 1 March 2018 were included. <h3>Methods</h3> SIRS criteria and qSOFA score were calculated for each patient. The first hospital treated the patients who met SIRS criteria following the worldwide Surviving Sepsis Campaign protocol. At the second hospital, only patients who met the qualifying qSOFA score received this treatment. Therefore, patients could be divided into five groups: (1) SIRS+, qSOFA−, not treated according to protocol (reference group); (2) SIRS+, qSOFA−, treated according to protocol; (3) SIRS+, qSOFA+, treated according to protocol; (4) SIRS−, qSOFA+, not treated according to protocol; (5) SIRS−, qSOFA+, treated according to protocol. <h3>Primary and secondary outcome measures</h3> To prove culture-positive sepsis was present, cultures were used as the primary outcome. Secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission. <h3>Results</h3> 98.9% met SIRS criteria and 11.7% met qSOFA score. Positive predictive values of SIRS criteria and qSOFA score were 41.2% (95% CI 37.4% to 45.2%) and 48.1% (95% CI 37.4% to 58.9%), respectively. HRs were 0.79 (95% CI 0.40 to 1.56, p=0.500), 3.42 (95% CI 1.82 to 6.44, p&lt;0.001), 18.94 (95% CI 2.48 to 144.89, p=0.005) and 4.97 (95% CI 1.44 to 17.16, p=0.011) for groups 2–5, respectively. <h3>Conclusion</h3> qSOFA score performed as well as SIRS criteria for identifying culture-positive sepsis and performed significantly better for predicting in-hospital mortality and ICU admission. This study shows that SIRS criteria are no longer necessary and recommends qSOFA score as the standard for identifying culture-positive sepsis in the ED. <h3>Trial registration number</h3> NL8315.