Abstract
Objective
To compare the time course of organ dysfunction/failure, mortality and cause of death in patients with severe sepsis (SS) and patients with severe non-infectious systemic inflammatory response syndrome (SNISIRS).
Design
Secondary analysis of a multi-centre inception cohort study.
Setting
Twenty-three multidisciplinary intensive care units (ICUs) in Australia and New Zealand.
Patients and participants
3,543 ICU admissions ≥48 h or <48 h if SIRS and organ dysfunction present.
Interventions
None.
Measurements and results
ICU prevalence of SS and SNISIRS was 20% (707/3,543) and 28% (980/3,543), respectively. ICU mortality was similar in patients with SNISIRS and with SS (25 vs. 27%, P = 0.40). Central nervous system (CNS) failure occurred more frequently in patients with SNISIRS (33 vs. 22%, P < 0.001) and resulted in death more commonly than in SS (relative risk = 1.6, 95% confidence interval 1.4–1.7, P < 0.001). The time to peak organ dysfunction (0.67 vs. 0.91 days, P = 0.004), overall episode length (3.6 vs. 5.6 days, P < 0.001) and ICU stay (geometric mean: 4.1 vs. 5.8 days, P < 0.001) were significantly shorter in patients with SNISIRS.
Conclusions
Whilst SNISIRS and SS have similarities, including their crude mortality rate, important differences exist. SNISIRS is more common on admission to the ICU, and is more commonly coupled with CNS dysfunction and death from neurological failure.
Descriptors
SIRS/sepsis: clinical studies.
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Acknowledgments
We wish to acknowledge the medical and nursing staff at the 21 participating hospitals that were associated with this research. Preparation of this manuscript was assisted by a grant from the Royal Brisbane and Women’s Hospital Research Foundation (Dr. Dulhunty).
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Appendix: Sepsis Study Investigators and affiliations
Appendix: Sepsis Study Investigators and affiliations
Simon Finfer, Royal North Shore Hospital, NSW, Australia
Rinaldo Bellomo, Austin Hospital, VIC, Australia
Andrew Bersten, Flinders Medical Centre, SA, Australia
Andrew Davies, Alfred Hospital, VIC, Australia
Geoffrey Dobb, Royal Perth Hospital, WA, Australia
Arthas Flabouris, Liverpool Hospital, NSW, Australia
Craig French, Western Hospital, VIC, Australia
David Green, Geelong Hospital, VIC, Australia
Stuart Green, Gold Coast Hospital, QLD, Australia
Felicity Hawker, Cabrini Hospital, VIC, Australia
Seton Henderson, Christchurch Hospital, New Zealand
Tamara Hunt, Flinders Medical Centre, SA, Australia
Chris Joyce, Princess Alexandra Hospital, QLD, Australia
Anthony Limpus, Princess Alexandra Hospital, QLD, Australia
Jeffrey Lipman, Royal Brisbane and Women’s Hospital, QLD, Australia
Colin MacArthur, Auckland Hospital, New Zealand
Eileen MacKenzie, Royal Perth Hospital, WA, Australia
Maria Magnaye, Royal North Shore Hospital, NSW, Australia
Imogen Mitchell, Royal Prince Alfred Hospital, NSW, Australia
Gordon Morris, Royal Perth Hospital, WA, Australia
John Myburgh, St. George Hospital, NSW, Australia
Lynette Newby, Auckland Hospital, New Zealand
James Nicholls, Canberra Hospital, ACT, Australia
Michael O’Leary, St. George Hospital, NSW, Australia
Graham Reece, Blacktown Hospital, NSW, Australia
Brent Richards, Gold Coast Hospital, QLD, Australia
Brigitte Roberts, Sir Charles Gairdner Hospital, WA, Australia
Tom Solano, Hornsby Hospital, NSW, Australia
Lorisa Soloveychik, Cabrini Hospital, VIC, Australia
Vladimir Szachin, Royal North Shore Hospital, NSW, Australia
Andrew Turner, Royal Hobart Hospital, TAS, Australia
Vernon Van Heerden, Sir Charles Gairdner Hospital, WA, Australia
Donna Wise, Austin Hospital, VIC, Australia
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Dulhunty, J.M., Lipman, J., Finfer, S. et al. Does severe non-infectious SIRS differ from severe sepsis?. Intensive Care Med 34, 1654–1661 (2008). https://doi.org/10.1007/s00134-008-1160-2
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DOI: https://doi.org/10.1007/s00134-008-1160-2