Predictive value of serum lactate combined with PIRO score in prognosis of septic patients / 中华急诊医学杂志

Objective To investigate the predictive value of serum lactate combined with PIRO (Predisposition,Infection,Response and Organ dysfunction) score in the development of multiple organs dysfunction syndrome (MODS) in septic patients and to study procalcitonin (PCT),in order to provide guidelines for clinical care.Methods From April 2015 to July 2016,a total of 752 sepsis patients were enrolled and divided into MODS group (n =488) and non-MODS group (n =264) according to the criteria of MODS.At 28 d after admission,these patients were divided into survival group (n =477) and death group (n =275).PCT and lactate levels in serum were measured,and PIRO score of these patients was calculated.Then the differences in levels of PCT and lactate in serum were compared among patients at different PIRO score categories.ROC was constructed to observe the clinical values of the biomarkers,PIRO score and lactate combined with PIRO score in predicting prognosis.Result PCT,lactate levels in serum and PIRO score were significantly higher in MODS group and death group,showing significant positive correlation.The areas under ROC curves (AUCs) of serum lactate combined with PIRO score for predicting MODS were 0.906,which was significantly higher than that of serum PCT (0.716),serum lactate (0.851) and PIRO score (0.840) alone (all P ＜ 0.05).Serum PCT,serum lactate and PIRO score were the independent predictors of MODS.Conclusions Serum lactate in combination with PIRO score was a valuable indicator in predicting development of MODS in septic patients.

Comparison of SAPS 3-PIRO score with other four scoring systems for assessing sepsis / 中华急诊医学杂志

Objective To investigate the feasibility of SAPS 3-PIRO score for prediction of outcomes in severe sepsis patients in the intensive care units (ICU).The optimal scoring system was also evaluated in this study.Methods Data of 677 patients with sepsis,treated in ICU of the emergency department at the Beijing Chaoyang Hospital between January 2008 and December 2011,were analyzed.The inclusion criteria were:age ≥18 years and the diagnostic criteria of severe sepsis and organ damage recommended by the International Sepsis Definitions Conference in Washington DC,USA in 2001,as well as the criteria developed by the Conference as a reference.The patients,who did not meet the criteria were excluded from the study.Age,gender,underlying disease,main infection site,and duration of ventilator support of all cases were recorded.Vital signs,hematological findings (gases,biochemistry,coagulation) and causative pathogens and organ damage on day-1 in the ICU were also recorded.According to the data of the most unfavorable findings in the ICU on day-1,scores got from APACHE Ⅱ,SOFA (sequential organ failure assessment),SAPS Ⅲ(simplified acute physiological score Ⅲ),SAPS 3-PIRO (predisposition,infection,response,organ failure/dysfunction) and MEDS (mortality in emergency department sepsis score) scoring systems were calculated.All patients were followed up for 28 days.The outcome of survival and death at 28 days were the endpoints of this study.SPSS V13.0 (SPSS,Chicago,IL,USA) was used to analyze data.Continuous variables with normal distribution were expressed as mean ± standard deviation.The independentsample t test was applied when normality (and homogeneity of variance) assumptions were fulfilled otherwise the t' test would be used.The distribution of categorical variables in two groups was tested using the x2 test.Binary logistic regression models were also used according to the survival status.The values of scoring system in predicting outcomes and the determination of dividing value in predicting death were analyzed using receiver operating characteristic (ROC) curves.The area under the receiver operating characteristic (AUROC) curves was compared using Z test.P values less than 0.05 were considered statistically significant.Results The total 28-day mortality was 41.9％.APACHE Ⅱ,SOFA,SAPS Ⅲ,SAPS 3-PIRO and MEDS scoring systems were used to find the independent predictive factors of death within 28 hours in patients with severe sepsis.By using ROC curve and AUROC curve to compare the validity of these scoring systems,SAPS 3-PIRO score had comparable predictive capability in comparison with APACHE Ⅱ,SOFA and SAPS Ⅲ scores,and MEDS was superior to SAPS 3-PIRO,APACHE Ⅱ,SOFA and SAPS Ⅲ score.Conclusions For patients with severe sepsis admitted in ICU,MEDS was superior to SAPS 3-PIRO,APACHE Ⅱ,SOFA and SAPS Ⅲ score in predicting prognosis.MEDS has favorable capability in predicting death within 28 days.MEDS ≥ 11 was the sign of increased mortality.SAPS 3-PIRO score has comparable predictive capability in comparison with APACHE Ⅱ,SOFA and SAPS Ⅲ score and it may be suggested for clinical practice.

Bacteremic pneumococcal pneumonia: serotype distribution, antimicrobial susceptibility, severity scores, risk factors, and mortality in a single center in Chile

AIMS: Bacteremic pneumococcal pneumonia (BPP) is a severe condition. To evaluate seasonal distribution, mortality, serotype frequencies, antimicrobial susceptibility, and different severity scores among patients with BPP. PATIENTS AND METHODS: Patients were identified by laboratory data and restricted to adulthood. Standard methods were used for serotyping and antimicrobial susceptibility. Risk factors were analyzed by univariate and multivariate methods. Severity scores (APACHE II, CURB-65 and CAP PIRO) were compared using ROC curves. RESULTS: Sixty events of community-acquired BPP occurred between 2005 and 2010. A seasonal pattern was detected. Mean age was 72.1 years old (81.4% >60 years). All had a predisposing factor. Previous influenza (3.3%) or pneumococcal immunization (1.7%) was infrequent. Admission to critical units was required by 51.7%. Twenty-two serotypes were identified among 59 strains. Only one strain had intermediate resistance to penicillin (1.7%). In-hospital mortality reached 33.3%. Multivariate analysis identified a CAP PIRO score>3 (OR 29.7; IC95 4.7-187), age >65 years (OR 42.1; IC95 2.2-796), and a platelet count<100,000/μL (OR 10.9; IC95 1.2-96) as significant independent factors associated with death. ROC curve analysis did not reveal statistical differences between the three severity scores to predict death (AUC 0.77-0.90). The prognostic yield for all of them was limited (Positive Likelihood Ratio: 1.5-3.8). CONCLUSIONS: BPP had a high case-fatality rate in this group of adult patients with no association to resistant isolates, and a low immunization record. Three independent factors were related to death and the prognostic yield of different severity scores was low. .

Clasificación PIRO en sepsis grave y shock séptico pediátrico: Nuevo modelo de estratificación y su utilidad en pronóstico / PIRO classification in pediatric severe sepsis and septic shock: A new model for staging and its potential usefulness in prognoses

Background: Sepsis is a dynamic process that involves complex interactions between the pathogenic micro-organisms and the host. The understanding of this heterogeneous disease has led to the development of a new system for stratification of septic patients: the PIRO system: Predisposition (P) -Insult/Infection (I) -Response (R) -Organ disfunction (O), a classification aimed to determine the risk of death in patients with sepsis. Only a few studies have validated this classification system in children. Objective: To empirically test the accuracy of the PIRO system in pediatric patients with septic shock and severe sepsis and associate its individual components to predict mortality. Patients and Method: A retrospective chart review was performed in a 13 bed PICU during 24 months (January 2006 to December 2007) Demographic, clinical and microbiological data were recorded in all patients with a diagnosis of septic shock and severe sepsis during the study period. For all patients the PIRO classification system was applied by one of four authors using paramethers measured at admission. Results: Atotal of 42 patients were included with a mean age of 11 months (range 3.25-58.3) of which 52 percent were male. Overall mortality was 19 percent and variables associated with mortality for each category were: (P) Chronic illness (OR: 7 IC95 percent 0.95-51) and Immunodeficiency (OR: 6.2; IC95 percent 1.1-35.2); (R) leucopema (OR 9; IC95 percent: 1.96-41.72); (O) more thanthree dysfunctional organs (OR: 6.1; IC95 percent: 1.22-31). None of the (I) variables were associated with mortality. Conclusions: The PIRO classification system identified factors associated with a fatal outcome in our population. The test is relatively simple to apply but cross-sectional studies are required to define variables associated with death that should then be prospectivelly validated.

Introducción: La compresión de la sepsis como un proceso dinámico, resultado de la interacción entre hospedero y agente infeccioso, ha llevado al sistema de estratificación "PIRO" (P) Predisposición, (I) Injuria/ Infección, (R) Respuesta y (O) disfunción de Órganos, clasificación orientada a predecir la muerte en pacientes con sepsis, a ganar adeptos. Sin embargo, faltan estudios clínicos que lo validen. Objetivo: Evaluar la certeza de la clasificación "PIRO" en sepsis grave y shock séptico para predecir mortalidad. Pacientes y Método: Estudio retrospectivo efectuado en una UCI pediátrica de 13 camas durante 24 meses (enero 2006 a diciembre 2007). Uno de los cuatro autores registró las características demográficas, clínicas y microbiológicas de la totalidad de pacientes ingresados con diagnóstico de sepsis grave y shock séptico, agrupándolos según sobrevida. Fueron clasificadas estas variables según sistema PIRO Se evaluó la asociación de estas variables con la mortalidad. Resultados: 42 pacientes, edad 11 meses (3,2-58) y mortalidad 19 por ciento. Las variables asociadas a mortalidad fueron: (P) antecedente de patología crónica (OR: 7; IC95 por ciento 0,95-51) e inmunodeficiencia (6,2; 1,1-35,2); (R) leucopenia (9; 1,96-41,72); (O) disfunción de 3 o más órganos (6,1; 1,22-31). Ninguna de las variables (I) se asoció a mortalidad. Conclusiones: El sistema "PIRO" es un modelo en desarrollo para una clasificación individual, de fácil aplicación. Permite reconocer factores asociados a un resultado fatal, en la presente casuística dado por inmunodeficiencia, leucopenia y fallo de tres o más sistemas. Es importante realizar estudios transversales para definir una etapificación PIRO consensuada y luego validarla prospectivamente.