Modified Criteria for the Systemic Inflammatory Response Syndrome Improves Their Utility Following Cardiac Surgery
| Autor: | Timothy W. Evans, Niall S. MacCallum, Gregory J. Quinlan, Simon J. Finney, Sarah E. Gordon |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Population Critical Care and Intensive Care Medicine Sensitivity and Specificity law.invention Cohort Studies Predictive Value of Tests law Internal medicine medicine Humans Prospective Studies Intensive care medicine education Survival rate Aged Retrospective Studies education.field_of_study business.industry Incidence Patient Selection Organ dysfunction Thoracic Surgery Retrospective cohort study Middle Aged medicine.disease Intensive care unit Systemic Inflammatory Response Syndrome Survival Rate Systemic inflammatory response syndrome Intensive Care Units Cardiothoracic surgery Predictive value of tests Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 145:1197-1203 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.13-1023 |
| Popis: | Background Debate remains regarding whether the systemic inflammatory response syndrome (SIRS) identifies patients with clinically important inflammation. Defining criteria may be disproportionately sensitive and lack specificity. We investigated the incidence and evolution of SIRS in a homogenous population (following cardiac surgery) over 7 days to establish the relationship between SIRS and outcome, modeling alternative permutations of the criteria to increase their discriminatory power for mortality, length of stay, and organ dysfunction. Methods We conducted a retrospective analysis of prospectively collected data from a cardiothoracic ICU. Consecutive patients requiring ICU admission for the first time after cardiac surgery (N = 2, 764) admitted over a 41-month period were studied. Results Concurrently, 96.2% of patients met the standard two criterion definition for SIRS within 24 h of ICU admission. Their mortality was 2.78%. By contrast, three or four criteria were more discriminatory of patients with higher mortality (4.21% and 10.2%, respectively). A test dataset suggested that meeting two criteria for at least 6 consecutive h may be the best model. This had a positive and negative predictive value of 7% and 99.5%, respectively, in a validation dataset. It performed well at predicting organ dysfunction and prolonged ICU admission. Conclusions The concept of SIRS remains valid following cardiac surgery. With suitable modification, its specificity can be improved significantly. We propose that meeting two or more defining criteria for 6 h could be used to define better populations with more difficult clinical courses following cardiac surgery. This group may merit a different clinical approach. |
| Databáze: | OpenAIRE |
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