Systemic inflammatory response syndrome and organ dysfunction following gastrointestinal surgery.
OBJECTIVE
Progression from systemic inflammatory response syndrome (SIRS) to sepsis, severe sepsis, and septic shock has been demonstrated in a variety of patients. However, the presence of SIRS alone was not helpful in predicting the development of multiple organ dysfunction syndrome (MODS) since SIRS includes many nonprogressive conditions. This study was conducted to investigate the clinical significance of SIRS in postoperative patients.


METHODS
Retrospective study.


METHODS
The surgical department of a university hospital.


METHODS
Two hundred ninety-two consecutive patients who received elective common gastrointestinal surgery (esophagectomy, pancreatoduodenectomy, hepatectomy, gastrectomy, colorectal resection, and laparoscopic cholecystectomy) between 1992 and 1995.


METHODS
Patients were analyzed for preoperative physiologic status, surgical stress parameters, and postoperative status of SIRS, complications, and end-organ dysfunction.


RESULTS
Duration of SIRS or positive criteria's number of SIRS after surgery significantly correlated with surgical stress parameters (blood loss/body weight and operation time) and peak serum C-reactive protein concentrations. SIRS that continued or reappeared after postoperative day 3 was an early sign of postoperative complications. SIRS continuing consecutively for 2 days after postoperative day 3 had a 70.6% positive predictive value and a 92.5% negative predictive value for postoperative complications. Septic complications and prolongation of SIRS were associated with MODS. Five of six patients who met the SIRS criteria for >30 days developed severe MODS, and three of them died.


CONCLUSIONS
SIRS is a useful criterion for the recognition of postoperative complications and end-organ dysfunctions. Early recovery from SIRS may arrest the progression of organ dysfunction.
Haga
Y
Y
Department of Surgery II, Kumamoto University Medical School, Japan.
Beppu
T
T
Doi
K
K
Nozawa
F
F
Mugita
N
N
Ikei
S
S
Ogawa
M
M
D000368:Aged; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000503:physiopathology