title: The predictive ability of a weighted systemic inflammatory response syndrome score for microbiologically confirmed infection in hospitalised patients with suspected sepsis.
abstract: BACKGROUND
  The systemic inflammatory response syndrome (SIRS) concept lacks sensitivity and specificity for guiding clinical practice and sepsis research.
  
  
  OBJECTIVE
  To assess the performance of a weighted SIRS score, with emphasis on white cell count and temperature criteria in predicting microbiologically confirmed infection.
  
  
  METHODS
  Prospective cohort study at Princess Alexandra Hospital, a tertiary teaching hospital in Queensland, Australia.
  
  
  METHODS
  Patients aged 18 years or older who were hospitalised with suspected infection and started on antimicrobial therapy.
  
  
  METHODS
  The utility of each SIRS criterion, the 1992 consensus conference recommendation (≤ 2 SIRS criteria) and a weighted SIRS score in predicting microbiologically confirmed infection were compared.
  
  
  RESULTS
  2085 patients were included in the analysis. All criteria performed poorly, with low sensitivities (27.3%-70.6%), low specificities (37.5%-77.5%), low positive predictive values (61.5%-65.3%), low negative predictive values (39.8%-45.1%), and likelihood ratios close to 1.0. Both SIRS and weighted SIRS scores did not perform better than clinicians' suspicion for infection.
  
  
  CONCLUSIONS
  Both SIRS and weighted SIRS score had low predictive ability for microbiologically confirmed infection. A more robust conceptual framework incorporating clinical, biochemical and immunological markers must be formulated and validated to better guide clinical practice and research. Clinicians' suspicions may be as good as any scoring system at identifying patients with infection and sepsis.
authors: Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia. Nai_An_Lai@health.qld.gov.au
authors: Nai An
authors: NA
authors: Lai
authors: Peter
authors: P
authors: Kruger
mesh_terms: D000368:Aged; D001831:Body Temperature; D003428:Cross Infection / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*