title: The systemic inflammatory response syndrome and sequential organ failure assessment scores are effective triage markers following paracetamol (acetaminophen) overdose.
abstract: BACKGROUND
  The systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores are widely used as prognostic markers in critical care settings and could improve triage of high-risk paracetamol (acetaminophen) overdose patients.
  
  
  OBJECTIVE
  To evaluate the prognostic accuracy of the SIRS and SOFA scores following single time point paracetamol overdose.
  
  
  METHODS
  Analysis of 100 single time point paracetamol overdoses admitted to a tertiary liver centre, with subsequent prospective validation of identified thresholds. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post-overdose, and the daily SOFA and SIRS scores calculated.
  
  
  RESULTS
  A total of 74 (74%) patients developed the SIRS, which occurred significantly earlier in patients who died (n=21) compared with spontaneous survivors (n=53, P=0.05). The SIRS occurred in 70 (70%) patients by 96h post-overdose, with a 30% mortality rate; compared with 0% mortality in the 30 non-SIRS patients (P=0.001). Median SOFA scores were significantly higher in nonsurvivors at 48 (P=0.009), 72 (P<0.001), and 96h (P<0.001). A SOFA score >7 during the first 96h post-overdose predicted death/transplantation with a sensitivity of 95.0 (95% CI 78.5-99.1) and specificity of 70.5 (95% CI 66.3-71.6). A validation cohort of 38 single time point paracetamol overdoses confirmed the extremely high negative predictive value of both the SIRS and SOFA thresholds.
  
  
  CONCLUSIONS
  The absence of either a SOFA score >7 or a SIRS response during the first 96 h following paracetamol overdose could improve triage and reduce transfers of lower risk patients to tertiary liver centres.
authors.affiliation: Scottish Liver Transplantation Unit, Royal Infirmary of Edinburgh, Little France, Edinburgh, UK.
authors.forename: D G N
authors.initials: DG
authors.lastname: Craig
authors.forename: T W D J
authors.initials: TW
authors.lastname: Reid
authors.forename: K G
authors.initials: KG
authors.lastname: Martin
authors.forename: J S
authors.initials: JS
authors.lastname: Davidson
authors.forename: P C
authors.initials: PC
authors.lastname: Hayes
authors.forename: K J
authors.initials: KJ
authors.lastname: Simpson
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D062787:Drug Overdose; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000401:mortality; D008297:Male; D009102:Multiple Organ Failure / Q000139:chemically induced* / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000139:chemically induced* / Q000401:mortality; D014218:Triage / Q000145:classification*
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen