Sepsis mortality prediction based on predisposition, infection and response.
OBJECTIVE
To empirically test, based on a large multicenter, multinational database, whether a modified PIRO (predisposition, insult, response, and organ dysfunction) concept could be applied to predict mortality in patients with infection and sepsis.


METHODS
Substudy of a multicenter multinational cohort study (SAPS 3).


METHODS
A total of 2,628 patients with signs of infection or sepsis who stayed in the ICU for >48 h. Three boxes of variables were defined, according to the PIRO concept. Box 1 (Predisposition) contained information about the patient's condition before ICU admission. Box 2 (Injury) contained information about the infection at ICU admission. Box 3 (Response) was defined as the response to the infection, expressed as a Sequential Organ Failure Assessment score after 48 h.


METHODS
None.


RESULTS
Most of the infections were community acquired (59.6%); 32.5% were hospital acquired. The median age of the patients was 65 (50-75) years, and 41.1% were female. About 22% (n=576) of the patients presented with infection only, 36.3% (n=953) with signs of sepsis, 23.6% (n=619) with severe sepsis, and 18.3% (n=480) with septic shock. Hospital mortality was 40.6% overall, greater in those with septic shock (52.5%) than in those with infection (34.7%). Several factors related to predisposition, infection and response were associated with hospital mortality.


CONCLUSIONS
The proposed three-level system, by using objectively defined criteria for risk of mortality in sepsis, could be used by physicians to stratify patients at ICU admission or shortly thereafter, contributing to a better selection of management according to the risk of death.
Moreno
Rui P
RP
Unidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central E.P.E., 1150-069 Lisbon, Portugal. r.moreno@mail.telepac.pt
Metnitz
Barbara
B
Adler
Leopold
L
Hoechtl
Anette
A
Bauer
Peter
P
Metnitz
Philipp G H
PG
D000368:Aged; D002908:Chronic Disease; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality*; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality; D016208:Databases, Factual; D004198:Disease Susceptibility; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D018805:Sepsis / Q000382:microbiology / Q000401:mortality*; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000382:microbiology / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000382:microbiology / Q000401:mortality