Utility of the systemic inflammatory response syndrome (SIRS) criteria in predicting the onset of septic shock in hospitalized patients with hematologic malignancies.
BACKGROUND
The systemic inflammatory response syndrome (SIRS) criteria have not been validated in patients with hematologic malignancies (HM).


OBJECTIVE
To determine whether daily assessment of SIRS criteria allows early identification of HM patients who will develop septic shock (SS).


METHODS
Observational, single-center,nested case-control study.


METHODS
Oncology unit of a tertiary care center.


METHODS
547 consecutive, hospitalized, HM subject were enrolled. Using incidence-density sampling, 184 controls were matched to 46 SS cases.


METHODS
The study exposure was the SIRS score. The study outcome was the development of SS during the hospitalization.


RESULTS
8.4% of subjects developed SS. SIRS scores measured 24 hours prior to SS were significantly higher in cases than in controls (2.1 vs. 1.4,p<0.0001). Using standard SIRS cutpoints, fever, tachypnea and tachycardia were each associated with the onset of SS. Population-specific SIRS criteria were empirically derived.


CONCLUSIONS
Single-center study. Further validation is warranted.


CONCLUSIONS
SIRS can identify HM patients at risk for SS at least 24 hours before SS onset. These data may lead to evidence-based guidelines using routine vital signs to risk-stratify HM patients for SS.
Mato
Anthony
A
Hematology & Oncology, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA. anthony.mato@uphs.upenn.edu
Fuchs
Barry D
BD
Heitjan
Daniel F
DF
Mick
Rosemarie
R
Halpern
Scott D
SD
Shah
Payal D
PD
Jacobs
Samamtha
S
Olson
Erin M
EM
Schuster
Stephen J
SJ
Ujjani
Chaitra
C
Chong
Elise A
EA
Loren
Alison W
AW
Miltiades
Andrea N
AN
Luger
Selina
S
D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis* / Q000517:prevention & control; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*