Signs Of Systemic Inflammatory Response Syndrome Research Articles

Does time elapsed between urine culture and retrograde intrarenal surgery affect the rate of systemic inflammatory response syndrome?

ObjectiveTo identify the preoperative and intraoperative factors that might cause systemic inflammatory response syndrome (SIRS) after retrograde intrarenal surgery (RIRS), and to investigate the effect of time elapsed between the date of performing preoperative bladder urine culture (PBUC) and surgery date on postoperative SIRS. Materials and methodsFour hundred sixty-seven patients who had RIRS between January 2013 and June 2020 constituted the target population of this study. PBUC were obtained from all patients before undergoing surgery. Postoperatively, patients were closely monitored for fever and other signs of SIRS. Univariate and multivariate logistic regression analysis were performed to reveal the predictive factors for SIRS after RIRS. ResultsThe entire study cohort consisted of 467 patients. The rate of SIRS was 5.6%. In univariate analysis, the rate of DM, recurrent urinary tract infection (UTI) history, surgical time, and stone burden were significant predictive factors for SIRS. In multivariate analysis, the rate of recurrent UTI history, surgical time and stone burden were observed to be statistically significant predictive factors. Time elapsed between the date of performing PBUC and surgery date was not different between the SIRS group and the normal group. ConclusionWe conclude that the time between the date of performing PBUC and surgery date is not an influential factor for SIRS. Clarifying this issue with prospective studies may be useful, as endourologists frequently encounter this situation in daily practice.

¿Existe asociación del tiempo entre el urocultivo y la cirugía intrarrenal retrógrada y la tasa de síndrome de respuesta inflamatoria sistémica?

ObjectiveTo identify the preoperative and intraoperative factors that might cause systemic inflammatory response syndrome (SIRS) after retrograde intrarenal surgery (RIRS), and to investigate the effect of time elapsed between the date of performing preoperative bladder urine culture (PBUC) and surgery date on postoperative SIRS. Materials and methodsFour hundred sixty-seven patients who had RIRS between January 2013 and June 2020 constituted the target population of this study. PBUC were obtained from all patients before undergoing surgery. Postoperatively, patients were closely monitored for fever and other signs of SIRS. Univariate and multivariate logistic regression analysis were performed to reveal the predictive factors for SIRS after RIRS. ResultsThe entire study cohort consisted of 467 patients. The rate of SIRS was 5.6%. In univariate analysis, the rate of diabetes mellitus, recurrent urinary tract infection history, surgical time, and stone burden were significant predictive factors for SIRS. In multivariate analysis, the rate of recurrent urinary tract infection history, surgical time and stone burden were observed to be statistically significant predictive factors. Time elapsed between the date of performing PBUC and surgery date was not different between the SIRS group and the normal group. ConclusionWe conclude that the time between the date of performing PBUC and surgery date is not an influential factor for SIRS. Clarifying this issue with prospective studies may be useful, as endourologists frequently encounter this situation in daily practice.

Does the duration between urine culture and percutaneous nephrolithotomy affect the rate of systemic inflammatory response syndrome postoperatively?

This study aimed to evaluate the preoperative and intraoperative factors that may cause systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to investigate the effect of the duration between urine culture (UC) and operation on postoperative SIRS. Three hundred and fifty-six patients who had PCNL between January 2015 and June 2019 were retrospectively included in the study. UC was obtained from all patients before the operation and during the puncture at the beginning of the operation. Postoperatively, patients were closely monitored for fever and other signs of SIRS. The post-PCNL SIRS incidence was 7%. In univariable and multivariable analyses, the rate of ipsilateral PCNL history, recurrent urinary tract infection (UTI) history, operation time and the length of hospital stay were significant predictive factors for SIRS. The duration between UC and PCNL was not a statistically significant variable in both univariable and multivariable analysis. Our study concluded that the duration between UC and PCNL is not an influential factor for post-PCNL SIRS. Clarifying this issue may be possible with prospective studies in which the effects of factors such as ipsilateral PCNL history and recurrent urinary tract infection history which has been proven to be risk factors for post-PCNL SIRS are restricted.

Systemic inflammatory response syndrome (SIRS) in complications of gallstone disease accompanied by mechanical jaundice (review of literature)

At present, the determination of the severity of patients with complications of acute calculous cholecystitis, manifested in the form of mechanical jaundice (MJ), remains an insufficiently studied issue. This is due to the fact that the main attention in the examination of such patients is paid to the diagnosis and assessment of the severity of liver failure, and the signs of SIRS (Systemic Inflammatory Response Syndrome) are not given due attention. In this regard, this literature review presents data on the systemic inflammatory response syndrome in such patients, describes its etiopathogenetic mechanisms of development, presents clinical signs, stages of this pathological process. The role of biomarkers, which can be used to determine the severity of inflammatory changes in the biliary system in MJ, is estimated on the basis of literature data.

Vital signs of the systemic inflammatory response syndrome in adult patients with acute infections presenting in out-of-hours primary care: A cross-sectional study

Background Signs of the systemic inflammatory response syndrome (SIRS) – fever (or hypothermia), tachycardia and tachypnoea – are used in the hospital setting to identify patients with possible sepsis. Objectives To determine how frequently abnormalities in the vital signs of SIRS are present in adult out-of-hours (OOH) primary care patients with suspected infections and assess the association with acute hospital referral. Methods We conducted a cross-sectional study at the OOH GP cooperative in Nijmegen, the Netherlands, between August and October 2015. GPs were instructed to record the body temperature, heart rate and respiratory rate of all patients with suspected acute infections. Vital signs of SIRS, other relevant signs and symptoms, and referral state were extracted from the electronic registration system of the OOH GP cooperative retrospectively. Logistic regression analysis was used to evaluate the association between clinical signs and hospital referral. Results A total of 558 patients with suspected infections were included. At least two SIRS vital signs were abnormal in 35/409 (8.6%) of the clinic consultations and 60/149 (40.3%) of the home visits. Referral rate increased from 13% when no SIRS vital sign was abnormal to 68% when all three SIRS vital signs were abnormal. Independent associations for referral were found for decreased oxygen saturation, hypotension and rapid illness progression, but not for individual SIRS vital signs. Conclusion Although patients with abnormal vital signs of SIRS were referred more often, decreased oxygen saturation, hypotension and rapid illness progression seem to be most important for GPs to guide further management.

Early recognition of surgical patients with sepsis: Contribution of nursing records

ObjectiveThis study aimed to analyze the contribution of nursing records to the early identification and management of sepsis in surgical patients at a university hospital. MethodThis is a study with a quantitative, retrospective, descriptive, and correlational design. Data collection was performed through hospital information systems in the first semester of 2017 with the approval of the research ethics committee. We included 28 patients who met the inclusion criteria of the study. ResultsThe analysis of the content of the records evidenced the development of the first signs of systemic inflammatory response syndrome (SIRS) and organ dysfunction until the fifth day of hospitalization in 19 patients (67.8%). Confirmation or hypothesis of sepsis diagnosis occurred until the 10th day of hospitalization in 15 patients (53.5%). The analysis of the content of the records showed that the first signs of SIRS were predominantly identified in the electronic patient monitoring system in 26 cases (92.9%), whereas the first signs of organ dysfunction were described in the nursing staff records in 24 patients (85.7%). ConclusionThe results confirm the importance of the quality of nursing records for risk identification, early recognition, and proper management of sepsis in surgical patients, aiming at achieving greater effectiveness in the management of healthcare processes.

Severity of Symptoms of Systemic Inflammatory Response Syndrome and Congestive Heart Failure Caused by Chronic Aortic Stenosis and Its Pharmacological Correction

Systemic inflammatory response syndrome (SIRS) is one of the key accompanied states that worsens severity of congestive heart failure (CHF) and leads refractory CHF to conventional therapy. We investigated whether the cessation of the symptoms and signs of SIRS prevents the progression of the CHF caused by chronic aortic stenosis in rabbits. 8 weeks after induced CHF by left descending coronary artery stenosis, all animals were randomly assigned into 3 groups: control (CG)—without therapy (infusion of 0.9% NaCl); main I— receive mg/kg of Adenocin® dissolved in water for injection i.v., once daily and main II—animals receive 0.25 mg/kg enalapril i.m, furosemide 1.0 mg/kg i.v. (bolus) and pimobendan 0.1 mg/kg i.v. once daily. All animals were euthanized after 14 days of the beginning of treatment. Long-term aortic stenosis leads to a simultaneously developing of CHF, diagnosed by developing cardiac hypertrophy, increased level of BNP and myocardial oedema and SIRS, confirmed by increasing markers and symptoms of endotoxemia, tissue dysoxia and decreasing reserve ability of intrinsic defense systems. Restoration of myocardium redox-potential and level of NAD under treatment with Adenocin® leads unlike combined treatment with enalapril, furosemide and pimobendan to restoration, the regulatory pathways of TNF-α synthesis, cessation of the hypoxic/ischemic, lysosomal dysfunction and free radical-induced damage in myocardium and symptoms of CHF. Potential important link between cellular metabolism (hypoxia/ischemia), endotoxemia and disturbances in intrinsic defense system is the level of redox-potentail, NAD/NADH in myocardium. Influence of oxidized form of NAD-containing positive inotropic drug Adenocin® leads to the decreasing symptoms of CHF and beneficial action occurs on all the key links of SIRS.

Value of interleukin-27 as a diagnostic biomarker of sepsis in critically ill adults

To evaluate interleukin-27 (IL-27) as a sepsis diagnostic biomarker in critically ill adults with sepsis. A retrospetive study was conducted. A total of 176 systemic inflammatory response syndrome (SIRS) patients in Department of Critical Care Medicine of Xinxiang Medical College First Affiliated Hospital from March to November in 2014 were enrolled. The patients were divided into no sepsis group (n=66), pulmonary originated sepsis group (n=65), and non-pulmonary originated sepsis group (n=45). Plasma IL-27 and procalcitonin (PCT) were determined with enzyme linked immunosorbent assay (ELISA). Receiver operating characteristic curve (ROC) and classification and regression tree methodology was used to evaluate diagnostic biomarker performance. The proportion of patients in pulmonary original sepsis group whose body temperature in line with SIRS criteria was significantly higher than no sepsis group (66.2% vs. 44.5%, P<0.05), and they were easy to suffer from tumor (44.6% vs. 22.7%, P<0.05). The proportion of patients in non-pulmonary originated sepsis group whose white blood cell count in line with SIRS criteria was significantly higher than no sepsis group (68.9% vs. 42.7%, P<0.05). It indicated that patients in pulmonary originated sepsis group and non-pulmonary originated sepsis group were more in line with SIRS criteria compared with no sepsis group. It was shown by ROC curve that IL-27 and PCT was not effective in discriminating sepsis among unselected patients showing symptoms and signs of SIRS. The area under the curve (AUC) was 0.59 [95% confidence interval (95%CI)=0.49-0.65] and 0.61 (95%CI=0.55-0.71). According to the further analysis from different infection sources, the highest AUC was 0.71 (95%CI=0.59-0.79) for IL-27 in patients with a non-pulmonary originated sepsis. A decision tree incorporating IL-27, PCT, and age had an AUC of 0.78 (95%CI=0.71-0.87) in patients with a non-pulmonary originated sepsis, which was higher than IL-27 [0.71(95%CI=0.59-0.79)] or PCT [0.65 (95%CI=0.57-0.78)]. Compared to that of pediatric cohort with sepsis, lower expression of IL-27 was found in adult patients. IL-27 performed overall poorly as a sepsis diagnostic biomarker in adults. IL-27 may be a more reliable diagnostic biomarker for sepsis in children than in adults. The combination of IL-27 and PCT can reasonably estimate the risk of sepsis in subjects with a non-pulmonary originated sepsis.

Avaliação do conhecimento dos estudantes de enfermagem sobre sepse

The purpose of this study was to evaluate the knowledge of undergraduate students in the last year of their nursing program in a Nursing School in the interior of the state of São Paulo, regarding systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. A descriptive quantitative study was developed with the participation of 77 students and the use of an instrument elaborated by the authors and validated in terms of its content and appearance. Participants reported they had little knowledge regarding the theme (58%) and that their nursing program provided little information regarding sepsis (65%). Only 26%, 12%, 19% and 26% respectively were able to recognize symptoms and signs of SIRS, sepsis, severe sepsis and septic shock. Results demonstrated that students have little knowledge regarding sepsis, and this may be related to a deficiency in the graduate course. Descriptors: Education, Nursing; Knowledge; Sepsis; Shock, Septic.

Qualité de vie liée à la santé et exposition chronique aux solvants organiques

This study aimed to analyze the contribution of nursing records to the early identification and management of sepsis in surgical patients at a university hospital.This is a study with a quantitative, retrospective, descriptive, and correlational design. Data collection was performed through hospital information systems in the first semester of 2017 with the approval of the research ethics committee. We included 28 patients who met the inclusion criteria of the study.The analysis of the content of the records evidenced the development of the first signs of systemic inflammatory response syndrome (SIRS) and organ dysfunction until the fifth day of hospitalization in 19 patients (67.8%). Confirmation or hypothesis of sepsis diagnosis occurred until the 10th day of hospitalization in 15 patients (53.5%). The analysis of the content of the records showed that the first signs of SIRS were predominantly identified in the electronic patient monitoring system in 26 cases (92.9%), whereas the first signs of organ dysfunction were described in the nursing staff records in 24 patients (85.7%).The results confirm the importance of the quality of nursing records for risk identification, early recognition, and proper management of sepsis in surgical patients, aiming at achieving greater effectiveness in the management of healthcare processes.

New era “soluble triggering receptor expressed on myeloid cells-I” as a marker for early detection of infection in trauma patients

BackgroundPrevious studies suggested that triggering receptor expressed on myeloid cells-1 is upregulated in the presence of infection.ObjectivesAssess the value of soluble triggering receptor expressed on myeloid cells-I (sTREM-I) in early differentiation of systemic inflammatory response syndrome (SIRS) from infection in trauma patients.DesignProspective study in Zagazig University Hospitals between January and September 2010. In Emergency Surgical Departments, Intensive Care of Anesthesia and Microbiology Department.ParticipantsEighty trauma patients divided into 10 patients without evidence of SIRS (control group), then 70 patients with two or more signs of SIRS were classified into low injury severity score group and high injury severity score group.MeasurementsPlasma concentration of sTREM-I in the three groups was compared. Sensitivity, specificity and predictive values of sTREM-I were compared with the results of procalcitonin. Also, microbiological cultures for infection were examined.ResultsThere was a highly significant increase in the level of sTREM-I in patients with sepsis (475.7 ± 97.9 for HISS group and 398.5 ± 103.9 for LISS group) than in the control group (102.7 ± 42.6). Also, there was a highly significant increase in its level in patients with sepsis (475.7 ± 97.9 for HISS group and 398.5 ± 103.9 for LISS group) in comparison to those with SIRS (189.3 ± 26.5 for HISS group and 177.2 ± 40 for LISS group). There was a highly significant increase in procalcitonin in septic patients in comparison to SIRS group (3.9 ± 0.86 for LISS and 7.1 ± 1.4 for HISS). The sensitivity and specificity of sTREM-I were significantly higher than those of procalcitonin (94.7% and 91.8% for sTREM-I and 84.2% and 75.4% for procalcitonin).ConclusionThe soluble TREM-I was a sensitive and specific marker for early differentiation of infection from SIRS in trauma patients.

Systemic inflammatory response and the incidence of bacteremia during biochemotherapy in metastatic melanoma

9615 Background: Standard of care calls for blood cultures to be drawn in patients with systemic inflammatory response syndrome (SIRS). Signs of SIRS, such as fevers, are expected using biochemotherapy with IL-2 and Interferon. This study evaluates the usefulness of routine blood cultures in patients who develop temperatures of 38.5o C or higher while treated with biochemotherapy. Methods: Charts of patients treated with biochemotherapy or high dose IL-2 for metastatic melanoma were reviewed at the University of Louisville from 2005 to 2007. The study objective was to estimate the frequency of true and false positive blood cultures. Results: A total of 205 blood cultures in 46 patients (27 male, 19 female) were reviewed. The average age was 63 years (25–71 years). The patients had an average of three cycles of biochemotherapy. The mean temperature of the febrile episodes was 38.7°C. The mean absolute neutrophil count was 5.1 K/mm3;, with extreme lows of less than 0.5 K/mm3; during treatment. Most patients had central lines placed at the initiation of treatment and had their central lines pulled at the end of the cycle. No patient was started on biochemotherapy while on antibiotics for a recent or acute infection. Out of these 205 febrile episodes only one blood culture was true positive. The patient had methicillin sensitive staph aureus bacteremia. There were five positive blood cultures thought to be false positive by the treating physician. 434 further febrile episodes on biochemotherapy were documented without blood cultures drawn. None of these patents were found to be infected during their biochemotherapy. Conclusions: Blood cultures during biochemotherapy/ IL-2 therapies are very inefficient in diagnosing clinically relevant bacteremia. The yield of true positive blood cultures in this setting is less than 3% (95% CI, 0–3%).There was however a significant number of false positive blood cultures. Unnecessary phlebotomies are an inconvenience to patients, are expensive and may be misleading by giving false positive results. No significant financial relationships to disclose.

Optimizing antibiotic usage in adults admitted with fever by a multifaceted intervention in an Indonesian governmental hospital

To optimize antimicrobial treatment of patients with fever upon admission to the department of internal medicine of Dr Soetomo Hospital in Surabaya, Indonesia. Prospective intervention study. The intervention comprised development of a consensus guideline, an official declaration of the guideline by the head of department, distributing a guideline pocketbook, carrying out blood cultures free of charge, teaching sessions and refresher courses. The outcome was measured with reference to (i) percentage of patients with fever started on antibiotic therapy, (ii) amount of antibiotics used expressed as defined daily doses (DDD)/100 patient-days, (iii) percentage of appropriate prescriptions and of prescriptions without indication as assessed by independent reviewers, (iv) percentage of treatments in accordance with guidelines, (v) percentage of patients in whom blood cultures were taken before starting antimicrobial therapy, (vi) percentage of treatments appropriately stopped on re-evaluation of the patients at 72 h and (vii) mortality. The study involved 501 patients, 95 residents and 60 specialists. After the intervention 17% patients less were treated with antibiotics upon admission and antibiotic use fell from 99.8 to 73 DDD/100 patient-days. The percentage of patients with sepsis and dengue treated in accordance with the guideline increased by 23% and 30%. The percentage of appropriate therapies, therapies without indication and mortality did not change significantly. The percentage of patients for whom a blood culture was taken upon admission increased from 3% to 81%; however, almost all were taken after they commenced antibiotic therapy. Therapy was not adjusted after 72 h in any case. Interrupted time series analysis showed that the start of development of the guideline and the declaration of the guideline were the interventions with the greatest impact. The multifaceted intervention had limited success. A very important drawback to the prudent use of antibiotics was the absence of adequate microbiological diagnostics.

Identification of diagnostic criteria of septic complications in children with neutropenia

Septic complications in neutropenic patients after chemotherapy lead to high morbidity and mortality in the pediatric oncology ward. There are no clear criteria of systemic inflammatory response syndrome (SIRS) and sepsis for neutropenic patients. It is usual that patients after chemotherapy have altered WBC, and the majority of them demonstrate tachycardia and mild to moderate fever (signs of SIRS) without infection. There is no clear differentiation between definitions of febrile neutropenia and sepsis for this group of patients.

Lipopolysaccharide-binding protein (LBP) and markers of acute-phase response in patients with multiple organ dysfunction syndrome (MODS) following open heart surgery.

Cardiopulmonary bypass (CPB) is associated with an immunological injury that may cause pathophysiological alterations in the form of a systemic inflammatory response syndrome (SIRS) or a multiple organ dysfunction syndrome (MODS). Previous studies on this issue have reported different changes of immunological parameters during and after CPB, but there are no reports about the lipopolysaccharide-binding protein (LBP) in relationship to other markers of inflammation in patients with MODS following cardiovascular surgery. In the present study, we investigated the acute-phase response of patients with MODS of infectious and non-infectious origin following open-heart-surgery. Plasma levels of procalcitonin (PCT), c-reactive protein (CRP), interleukin-6 (IL-6), and LBP were measured in the first four postoperative days in 12 adult male patients with the signs of SIRS and two or more organ dysfunctions after myocardial revascularization (MODS-group), and 12 patients without organ insufficiencies (SIRS-group). There were no significant differences regarding age, weight, height, preoperative NYHA-classification, preoperative LVEDP, or the number of anastomosis. Patients with MODS had a significantly longer operation time, duration of ischemia, and duration of extracorporeal circulation. None of the patients in the SIRS group died, whereas in the MODS group, 4 patients died due to septic multiorgan failure. Plasma PCT and IL-6 concentrations were significantly elevated in all MODS patients. CRP and LBP showed no differences between the MODS and the SIRS group. Comparing the MODS patients with and without positive microbial findings, we found significantly elevated levels of PCT and LBP in those patients with documented infections. Our results indicate that LBP may be a new marker for the differentiation between a severe non-infectious SIRS and an ongoing bacterial sepsis in the early postoperative course following CPB, while a microbiological result is still missing.

Pilot study of cytokines in emergency department patients with systemic inflammatory response syndrome.

To determine the potential utility of cytokine and arachidonic acid metabolite levels in ED patients with systemic inflammatory response syndrome (SIRS) as a predictor of progression to severe sepsis. A prospective, observational study of test performance was performed using convenience samples of adult control subjects and admitted patients. The latter patients were identified in the ED as having signs of SIRS. Level of cytokines and arachidonic acid metabolites measured from specimens obtained in the ED were compared between groups and associated with the progression of sepsis within 24 hours in the SIRS patients. There were 30 control patients and 29 SIRS patients. There were 8 SIRS subjects who progressed to severe sepsis within 24 hours using the following criteria (hypotension, n = 1; and organ dysfunction, n = 2). Of the 21 SIRS subjects who did not progress to severe sepsis, 11 had resolution of SIRS criteria at 24 hours. There were no significant differences in mean mediator levels between the SIRS patients who progressed to severe sepsis and those who did not. Of the 11 patients with resolution of SIRS criteria at 24 hours, the mean interleukin-6 (IL-6) level was significantly lower than that for the patients who did not recover or who progressed at 24 hours (n = 18); 65.4 +/- 49.1 vs 230 +/- 112 pg/mL, p = 0.001). Six of 15 subjects with IL-6 > 150 pg/mL progressed to severe sepsis (p = NS). Using threshold values based on the range of levels for normals, the sensitivity of an abnormal marker for the development of severe sepsis within 24 hours varied from 50% to 87%, while the specificity varied from 11% to 84%. While mean levels were significantly elevated when compared with those of normal control subjects, they had limited ability to predict the subset of patients likely to progress to severe sepsis. However, initial low levels of cytokines may have exclusionary prognostic value. Prospective validation of the latter finding is warranted.