title: The duration of SIRS before organ failure is a significant prognostic factor of sepsis.
abstract: BACKGROUND
  The mortality rate of patients complicated with sepsis-associated organ failure remains high in spite of intensive care treatment. The purpose of this study was to define the duration of systemic inflammatory response syndrome (SIRS) before organ failure (DSOF) and determine the value of DSOF as a prognostic factor in septic patients.
  
  
  METHODS
  This retrospective cohort study was conducted in an 11-bed medical and surgical intensive care unit (ICU) in a university hospital. The primary endpoint was in-hospital mortality of the septic patients.
  
  
  RESULTS
  One hundred ten septic patients with organ failure and/or shock were enrolled in this study. The in-hospital mortality rate was 36.9%. The median DSOF was 28.5 h. As a metric variable, DSOF was a statistically significant prognostic factor according to univariate analysis (survivor: 74.7 ± 9.6 h, non-survivor: 58.8 ± 16.5 h, p = 0.015). On the basis of the ROC curve, we defined an optimal cutoff of 24 h, with which we divided the patients as follows: group 1 (n = 50) comprised patients with a DSOF ≤24 h, and group 2 (n = 60) contained patients with a DSOF >24 h. There were statistically significant differences in the in-hospital mortality rate between the two groups (52.0% vs. 25.0%, p = 0.004). Furthermore, by multivariate analysis, DSOF ≤24 h (odds ratio: 5.89, 95% confidence interval: 1.46-23.8, p = 0.013) was a significant independent prognostic factor.
  
  
  CONCLUSIONS
  DSOF may be a useful prognostic factor for severe sepsis.
authors.affiliation: Department of Gastroenterological Surgery, Graduate School of, Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 8608556, Japan. sugitaf@ba2.so-net.ne.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugita
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba