Evaluation of updated sepsis scoring systems and systemic inflammatory response syndrome criteria and their association with sepsis in equine neonates
David M. WongRebecca E. RubyKatarzyna A. DembekBonnie S. BarrSarah M. ReussK. Gary MagdesianE. G. J. OlsenTeresa A. BurnsNathan M. SlovisPamela A. Wilkins
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Background The original equine sepsis score provided a method of identifying foals with sepsis. New variables associated with sepsis have been evaluated, but the sepsis score has not been updated. Objectives To evaluate the sensitivity and specificity of 2 updated sepsis scores and the systemic inflammatory response syndrome (SIRS) criteria in regard to detecting sepsis in foals. Animals Two‐hundred and seventy‐three ill foals and 25 healthy control foals. Methods Historical, physical examination, and clinicopathologic findings were used to calculate the original sepsis score and 2 updated sepsis scores. SIRS criteria were also evaluated. Sepsis scores and positive SIRS scores were statistically compared to foals with sepsis. Results One‐hundred and twenty‐six foals were septic and 147 sick‐nonseptic. The original and updated sepsis scores were significantly higher in septic foals as compared to sick‐nonseptic and healthy foals. The sensitivity and specificity of the updated sepsis scores to predict sepsis were not significantly better than those of the original sepsis score. One‐hundred and twenty‐seven of 273 (46.5%) foals met the original SIRS criteria and 88/273 (32%) foals met the equine neonatal SIRS criteria. The original SIRS criteria had similar sensitivity and specificity for predicting sepsis as did the 3 sepsis scores in our study. Conclusions and Clinical Importance The updated sepsis scores did not provide improved ability in predicting sepsis. Fulfilling the original SIRS criteria provided similar sensitivity and specificity in predicting sepsis as the modified sepsis score and might serve as a diagnostic aid in identifying foals at risk for sepsis.Analysis of biochemical transformations occurring in the course of SIRS and sepsis inclines a critical attitude towards, obligatory nowadays, criteria of these states. They are non-specific and, in an unsatisfying way, they define the state of a current immunological response of the organism from the laboratory as well as clinical point of view. The purpose of the project of a new approach to sepsis--PIRO is to create a more objective, measurable system of evaluation of clinical state of a patient suspected of sepsis.
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This is an observational study which aims to research morphological changes of white blood cells in patients with Systemic Inflammatory Response Syndrome (SIRS) with and without sepsis and evaluate morphological changes in white blood cells as predictors of sepsis.Patients aged 18 years or more with SIRS with sepsis and SIRS without sepsis were included and those with haematological disorders or pregnant patients were excluded. A total of 52 patients with SIRS with sepsis and 32 patients of SIRS without sepsis were included. Peripheral blood smear was prepared from the venous blood sample drawn. The presence of toxic granules, cytoplasmic vacuoles, and Dohle bodies in both cases of SIRS with sepsis without sepsis were assessed and it was compared with culture-positive sepsis and shock.The difference in the presence of toxic granules (55.8% vs. 12.5%; p <0.001), cytoplasmic vacuoles (30.8% vs. 6.3%; p -0.012), and Dohle bodies (17.3% vs. 0%; p = 0.012) was significantly higher in the SIRS with sepsis group, compared to the SIRS without sepsis group. In the subgroup analysis of patients in the sepsis group, it was observed that patients with positive blood culture (9%) had a significantly higher proportion of toxic granules (100% vs. 51.1%; p=0.059), cytoplasmic vacuoles (40% vs. 29.8%; p=0.637) and Dohle bodies (40% vs. 14.9%; p=0.202). However, these differences were not statistically significant.Toxic granules and cytoplasmic vacuoles in the neutrophils of patients with SIRS with sepsis were found more frequently, compared to patients of SIRS without sepsis. Dohle bodies were found only in patients with sepsis and not in those with SIRS without sepsis.
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The concept of systemic inflammatory response syndrome (SIRS) was introduced in 1992 to define and objectively diagnose sepsis. Over the last decade, the definition of sepsis has been used for inclusion criteria of multicenter trials to develop innovative therapies of sepsis. With the recent understanding of the pathogenetic mechanisms of sepsis, many drugs have been tested, but only two drugs (activated protein C and neutrophil-elastase inhibitor) have been approved for clinical use in sepsis or SIRS. Further understanding of basic pathophysiology of SIRS and sepsis holds promise to develop a new therapeutic strategy to improve survival of patients with SIRS and sepsis.
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Sepsis caused by infection remains a major cause of mortality and morbidity among children.Several inflammatory markers have failed to meet the requirements for early diagnosis of sepsis.We saw the potential value of measuring the total leukocyte count and the inflammatory markers C reactive protein (CRP), procalcitonin (PCT) and interleukin (IL) 6 in patients with SIRS for early identifying of sepsis.Children with SIRS (n = 52) were included in a prospective study.Changes in the total leukocyte count and levels of inflammatory markers and their inter-correlations were evaluated in SIRS and sepsis patients at different time points.Sepsis was recognized in 21% of the SIRS patients.There was a statistically significant difference between PCT and CRP levels in the SIRS and sepsis patient groups.In patients with sepsis, the IL6 level at the outset of the study had a mean value of 476.68 ± 955.137 pg/ml, which differed significantly from the mean IL6 level in SIRS patients (51.3 ± 137.5 pg/ml).The IL6 level in sepsis patients decreased significantly after 24 hours.We conclude that SIRS and sepsis patients differed significantly in respect of changes in CRP, PCT and IL6 levels.In view of the relatively small number of subjects in the sepsis group we can only suggest that special attention should be paid to SIRS patients with elevated levels of those indicators.A continuing search for specific and sensitive inflammatory markers and their combinations in SIRS patients is required so that sepsis can be diagnosed early enough.
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Sepsis,the systemic inflammatory response syndrome(SIRS)induced by infection,is the first cause of death of patients in intensive care unit. Early diagnosis of sepsis with the actions of corresponding treatment can improve the prognosis of sepsis.It is an appropriate way to achieve early diagnosis of sepsis that using proteomics methods to detect unknown proteins during early stage of sepsis,in which we search for new protein biomarkers.
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Sepsis; Systemic inflammatory response syndrome; Proteomies
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Background The original equine sepsis score provided a method of identifying foals with sepsis. New variables associated with sepsis have been evaluated, but the sepsis score has not been updated. Objectives To evaluate the sensitivity and specificity of 2 updated sepsis scores and the systemic inflammatory response syndrome (SIRS) criteria in regard to detecting sepsis in foals. Animals Two‐hundred and seventy‐three ill foals and 25 healthy control foals. Methods Historical, physical examination, and clinicopathologic findings were used to calculate the original sepsis score and 2 updated sepsis scores. SIRS criteria were also evaluated. Sepsis scores and positive SIRS scores were statistically compared to foals with sepsis. Results One‐hundred and twenty‐six foals were septic and 147 sick‐nonseptic. The original and updated sepsis scores were significantly higher in septic foals as compared to sick‐nonseptic and healthy foals. The sensitivity and specificity of the updated sepsis scores to predict sepsis were not significantly better than those of the original sepsis score. One‐hundred and twenty‐seven of 273 (46.5%) foals met the original SIRS criteria and 88/273 (32%) foals met the equine neonatal SIRS criteria. The original SIRS criteria had similar sensitivity and specificity for predicting sepsis as did the 3 sepsis scores in our study. Conclusions and Clinical Importance The updated sepsis scores did not provide improved ability in predicting sepsis. Fulfilling the original SIRS criteria provided similar sensitivity and specificity in predicting sepsis as the modified sepsis score and might serve as a diagnostic aid in identifying foals at risk for sepsis.
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The terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock and multiorgan failure (MOF) are currently used to characterize the progressive stages of a very complex and therapeutically challenging disorder of the immune and inflammatory systems. Although SIRS is a result of a systemic activation of the innate immune system regardless of cause, sepsis, severe sepsis, and septic shock are accompanied by proven or suspected infection with or without impaired organ function. Despite tremendous research efforts for over 20 years, sepsis remains the leading cause of death in intensive care units (ICUs). SIRS and sepsis occur in approximately 750,000 patients per year in the United States, with a rising incidence of approximately 1.5% per year (1). With a mortality rate of currently 30% to 70%, sepsis and related disorders represent a major burden to the U.S. health care system, with costs estimated to be approximately $16.7 billion per year (2).
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