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Moreno, RP; Metnitz, B; Adler, L; Hoechtl, A; Bauer, P; Metnitz, PG; SAPS 3 Investigators.
Sepsis mortality prediction based on predisposition, infection and response.
Intensive Care Med. 2008; 34(3):496-504 Doi: 10.1007/s00134-007-0943-1
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Metnitz Philipp

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To empirically test, based on a large multicenter, multinational database, whether a modified PIRO (predisposition, insult, response, and organ dysfunction) concept could be applied to predict mortality in patients with infection and sepsis. Substudy of a multicenter multinational cohort study (SAPS 3). A total of 2,628 patients with signs of infection or sepsis who stayed in the ICU for >48 h. Three boxes of variables were defined, according to the PIRO concept. Box 1 (Predisposition) contained information about the patient's condition before ICU admission. Box 2 (Injury) contained information about the infection at ICU admission. Box 3 (Response) was defined as the response to the infection, expressed as a Sequential Organ Failure Assessment score after 48 h. None. Most of the infections were community acquired (59.6%); 32.5% were hospital acquired. The median age of the patients was 65 (50-75) years, and 41.1% were female. About 22% (n=576) of the patients presented with infection only, 36.3% (n=953) with signs of sepsis, 23.6% (n=619) with severe sepsis, and 18.3% (n=480) with septic shock. Hospital mortality was 40.6% overall, greater in those with septic shock (52.5%) than in those with infection (34.7%). Several factors related to predisposition, infection and response were associated with hospital mortality. The proposed three-level system, by using objectively defined criteria for risk of mortality in sepsis, could be used by physicians to stratify patients at ICU admission or shortly thereafter, contributing to a better selection of management according to the risk of death.
Find related publications in this database (using NLM MeSH Indexing)
Aged -
Chronic Disease -
Community-Acquired Infections - microbiology
Community-Acquired Infections - mortality
Cross Infection - microbiology
Cross Infection - mortality
Databases, Factual -
Disease Susceptibility -
Female -
Gram-Positive Bacterial Infections - microbiology
Gram-Positive Bacterial Infections - mortality
Hospital Mortality -
Humans -
Intensive Care Units -
Male -
Middle Aged -
Multiple Organ Failure - etiology
Multiple Organ Failure - mortality
Prognosis -
Sepsis - microbiology
Sepsis - mortality
Severity of Illness Index -
Shock, Septic - microbiology
Shock, Septic - mortality
Systemic Inflammatory Response Syndrome - microbiology
Systemic Inflammatory Response Syndrome - mortality

Find related publications in this database (Keywords)
intensive care unit
severity of illness
risk adjustment
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