The Systemic Inflammatory Response Syndrome (SIRS)--number and type of positive criteria predict interventions and outcomes in acute surgical admissions.
BACKGROUND
Systemic inflammatory response syndrome (SIRS) is a syndrome that reflects the widespread activation of inflammatory pathways. The goal of this study was to find whether the presence or absence of SIRS on emergency surgical admissions is related to the subsequent clinical outcome in terms of in-hospital interventions, length of stay, and mortality.


METHODS
The presence of SIRS at admission, final diagnosis of the underlying disease, treatments, and clinical outcomes were prospectively recorded for 1 month. Comparisons of interventions and outcomes were performed between SIRS+ vs. SIRS- patients. In patients with SIRS, the contribution of each positive criterion was evaluated with regards to mortality.


RESULTS
A total of 179 patients were recruited. The prevalence of SIRS at admission was 35.2%. SIRS+ patients required less diagnostic procedures compared with SIRS- (28.6% vs. 34.5%) but had more therapeutic interventions (39.7% vs. 16.4%), surgical interventions (33.3% vs. 3.4%), intensive treatments (11.1% vs. 0.9%; p < 0.05), longer hospital stay (median 6 days vs. 2 days), and more frequent deaths (11.1% vs. 2.6%). SIRS+ patients with four positive criteria had more surgical interventions, intensive treatments, and fatal outcomes compared with the others. Of importance the most influent factor was the respiratory rate followed by the white cell count and the heart rate/temperature.


CONCLUSIONS
Patients with SIRS at admission apparently receive more interventions, have longer length of stay, and increased mortality than those patients without SIRS. These findings require separate validation in a larger cohort study.
Stephenson
James A
JA
Department of Surgery, University Hospitals of Leicester, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, LE2 7LX, Leicester, UK. jastephenson@doctors.org.uk
Gravante
Gianpiero
G
Butler
Nicholas A
NA
Sorge
Roberto
R
Sayers
Rob D
RD
Bown
Matt J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult