title: Modified criteria for the systemic inflammatory response syndrome improves their utility following cardiac surgery.
abstract: BACKGROUND
  Debate remains regarding whether the systemic inflammatory response syndrome (SIRS) identifies patients with clinically important inflammation. Defining criteria may be disproportionately sensitive and lack specificity. We investigated the incidence and evolution of SIRS in a homogenous population (following cardiac surgery) over 7 days to establish the relationship between SIRS and outcome, modeling alternative permutations of the criteria to increase their discriminatory power for mortality, length of stay, and organ dysfunction.
  
  
  METHODS
  We conducted a retrospective analysis of prospectively collected data from a cardiothoracic ICU. Consecutive patients requiring ICU admission for the first time after cardiac surgery (N = 2,764) admitted over a 41-month period were studied.
  
  
  RESULTS
  Concurrently, 96.2% of patients met the standard two criterion definition for SIRS within 24 h of ICU admission. Their mortality was 2.78%. By contrast, three or four criteria were more discriminatory of patients with higher mortality (4.21% and 10.2%, respectively). A test dataset suggested that meeting two criteria for at least 6 consecutive h may be the best model. This had a positive and negative predictive value of 7% and 99.5%, respectively, in a validation dataset. It performed well at predicting organ dysfunction and prolonged ICU admission.
  
  
  CONCLUSIONS
  The concept of SIRS remains valid following cardiac surgery. With suitable modification, its specificity can be improved significantly. We propose that meeting two or more defining criteria for 6 h could be used to define better populations with more difficult clinical courses following cardiac surgery. This group may merit a different clinical approach.
authors.affiliation: Unit of Critical Care, Biomedical Research Unit, Imperial College London, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England.
authors.forename: Niall S
authors.initials: NS
authors.lastname: MacCallum
authors.affiliation: Unit of Critical Care, Biomedical Research Unit, Imperial College London, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Finney
authors.affiliation: Unit of Critical Care, Biomedical Research Unit, Imperial College London, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Gordon
authors.affiliation: Unit of Critical Care, Biomedical Research Unit, Imperial College London, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Quinlan
authors.affiliation: Unit of Critical Care, Biomedical Research Unit, Imperial College London, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, England. Electronic address: t.evans@rbht.nhs.uk.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Evans
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D013903:Thoracic Surgery; D013997:Time Factors