Chest
Original ResearchSevere Sepsis in Community-Acquired Pneumonia: When Does It Happen, and Do Systemic Inflammatory Response Syndrome Criteria Help Predict Course?
Section snippets
Materials and Methods
The Institutional Review Board of the University of Pittsburgh approved this research study. All participants signed an informed consent form.
Results
Of the 2,287 patients enrolled in the PORT cohort in the ED, 1,343 patients were admitted. Of the 1,343 patients, 1,339 patients had complete organ dysfunction data and formed the study population. Of these 1,339 patients, 170 patients (12.7%) were admitted to the ICU at some point. We described the baseline characteristics of the study population previously.22 One half of the patients (n = 669, 49.96%) had a PSI class of IV or V, conferring a 30-day mortality risk of ≥ 8.5%.15 We collected the
Discussion
We demonstrated that SIRS criteria measured as early as the patient's presentation to the ED are poorly predictive of severe sepsis, shock, and death in pneumonia patients. Once the cornerstone of the sepsis definition, SIRS appears to be of very limited use in forecasting any of the adverse events in the sepsis cascade. Our results show for the first time that this holds true for a mixture of ICU and non-ICU patients even when SIRS is present very early during their hospital course. However,
Appendix
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
This research was partly funded by the Agency for Health Care Policy and Research (R01 HSO 6468) as part of the Pneumonia Patient Outcomes Research Team, and by the National Institute of General Medical Sciences (R01 GM61992) as part of the Genetic and Inflammatory Markers of Sepsis project.
The work was performed at the University of Pittsburgh, Pittsburgh, PA.