title: Predisposition, insult/infection, response and organ dysfunction (PIRO): a pilot clinical staging system for hospital mortality in patients with infection.
abstract: OBJECTIVE
  To develop a clinical staging system based on the PIRO concept (Predisposition, Infection, RESPONSE and Organ dysfunction) for hospitalized patients with infection.
  
  
  METHODS
  One year prospective cohort study of all hospitalized patients with infection (n = 1035), admitted into a large tertiary care, university hospital. Variables associated with hospital mortality were selected using logistic regressions. Based on the regression coefficients, a score for each PIRO component was developed and a classification tree was used to stratify patients into four stages of increased risk of hospital mortality. The final clinical staging system was then validated using an independent cohort (n = 186).
  
  
  RESULTS
  Factors significantly associated with hospital mortality were • for Predisposition: age, sex, previous antibiotic therapy, chronic hepatic disease, chronic hematologic disease, cancer, atherosclerosis and a Karnofsky index<70; • for Insult/Infection: type of infection • for
  
  
  RESULTS
  abnormal temperature, tachypnea, hyperglycemia and severity of infection and • for Organ dysfunction: hypotension and SOFA score≥1. The area under the ROC curve (CI95%) for the combined PIRO model as a predictor for mortality was 0.85 (0.82-0.88). Based on the scores for each of the PIRO components and on the cut-offs estimated from the classification tree, patients were stratified into four stages of increased mortality rates: stage I: ≤5%, stage II: 6-20%, stage III: 21-50% and stage IV: >50%. Finally, this new clinical staging system was studied in a validation cohort, which provided similar results (0%, 9%, 31% and 67%, in each stage, respectively).
  
  
  CONCLUSIONS
  Based on the PIRO concept, a new clinical staging system was developed for hospitalized patients with infection, allowing stratification into four stages of increased mortality, using the different scores obtained in Predisposition, RESPONSE, Infection and Organ dysfunction. The proposed system will likely help to define inclusion criteria in clinical trials as well as tailoring individual management plans for patients with infection.
authors.affiliation: Intensive Care Unit, Unidade de Cuidados Intensivos Polivalente, Hospital de Santo António, University of Porto, Porto, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cardoso
authors.forename: Armando
authors.initials: A
authors.lastname: Teixeira-Pinto
authors.forename: Pedro Pereira
authors.initials: PP
authors.lastname: Rodrigues
authors.forename: Irene
authors.initials: I
authors.lastname: Aragão
authors.forename: Altamiro
authors.initials: A
authors.lastname: Costa-Pereira
authors.forename: António E
authors.initials: AE
authors.lastname: Sarmento
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004198:Disease Susceptibility / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors
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