Critical illness-related corticosteroid insufficiency in dogs with systemic inflammatory response syndrome: A pilot study in 21 dogs
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ACTH stimulation test
White blood cell
Basal (medicine)
ACTH stimulation test
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Leukocytosis
White blood cell
Erythrocyte sedimentation rate
Bacteremia
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Lifesaving early distinction of infectious systemic inflammatory response syndrome, known as "sepsis," from noninfectious systemic inflammatory response syndrome is challenging in the ICU because of high systemic inflammatory response syndrome prevalence and lack of specific biomarkers. The purpose of this study was to use an automatic algorithm to detect systemic inflammatory response syndrome criteria (tachycardia, tachypnea, leukocytosis, and fever) in surgical ICU patients for ICU-wide systemic inflammatory response syndrome prevalence determination and evaluation of algorithm-derived systemic inflammatory response syndrome descriptors for sepsis prediction and diagnosis in a polytrauma cohort.Cross-sectional descriptive study and retrospective cohort study.Electronic medical records of a tertiary care center's surgical ICU, 2006-2011.All ICU admissions and consecutive polytrauma admissions.None.Average prevalence of conventional systemic inflammatory response syndrome (≥ 2 criteria met concomitantly) from cross-sectional application of the algorithm to all ICU patients and each minute of the study period was 43.3%. Of 256 validated polytrauma patients, 85 developed sepsis (33.2%). Three systemic inflammatory response syndrome descriptors summarized the 24 hours after admission and before therapy initiation: 1) systemic inflammatory response syndrome criteria average for systemic inflammatory response syndrome quantification over time, 2) first-to-last minute difference for trend detection, and 3) change count reflecting systemic inflammatory response syndrome criteria fluctuation. Conventional systemic inflammatory response syndrome for greater than or equal to 1 minute had 91% sensitivity and 19% specificity, whereas a systemic inflammatory response syndrome criteria average cutoff value of 1.72 had 51% sensitivity and 77% specificity for sepsis prediction. For sepsis diagnosis, systemic inflammatory response syndrome criteria average and first-to-last minute difference combined yielded 82% sensitivity and 71% specificity compared with 99% sensitivity and only 31% specificity of conventional systemic inflammatory response syndrome from a nested case-control analysis.Dynamic systemic inflammatory response syndrome descriptors improved specificity of sepsis prediction and particularly diagnosis, rivaling established biomarkers, in a polytrauma cohort. They may enhance electronic sepsis surveillance once evaluated in other patient populations.
Polytrauma
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The pathophysiology of severe acute pancreatitis (AP) resembles other conditions with systemic inflammatory response syndrome (SIRS) such as sepsis predisposing to remote organ failure. Because extracellular phospholipases A2 (PLA2) have been implicated in AP, their serum concentrations were analyzed with respect to SIRS and systemic complications in patients with severe AP. The serum samples were collected daily for 12 days in 57 patients with severe AP. SIRS, early organ complications, local complications, and outcome of AP were recorded. Time-resolved fluoroimmunoassays were used for group I and group II PLA2 measurements. Thirty-nine (68.4%) patients fulfilled the criteria of SIRS within 12 days from admission. Pancreatic necrosis was detected in 43 (75.4%) patients. Infected necrosis was found preoperatively or at operation in five (8.8%) patients. Twenty-six (45.6%) and eight (14.0%) patients had respiratory or renal failure, respectively. Seven (12.3%) patients died of their disease. All patients with systemic complications fulfilled the criteria of SIRS. The increasing number of positive SIRS criteria was associated with increased frequency of systemic complications. Pancreatic necrosis was not significantly associated with SIRS. The serum concentration of group II PLA2 was significantly higher in patients with SIRS (p <0.05) compared with patients without from day 7 onward. The concentration of group II PLA2 increased (p <0.01) in patients with SIRS but decreased in patients without. The serum concentration of group II PLA2 did not differ significantly with respect to systemic complications. The concentration of group I PLA2 decreased (p <0.05) similarly in patients with and without SIRS or systemic complications during follow-up, respectively. Early systemic complications of severe AP are associated with SIRS with increasing frequency as the number of positive SIRS criteria increases. Group II PLA2 but not group I PLA2 may have pathophysiologic importance in severe AP-associated SIRS. Increasing serum concentration of group II PLA2 seems to reflect the ongoing systemic inflammation in severe AP-associated SIRS.
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Severe systemic inflammatory response syndrome in critical patients—an clinical analysis of 72 cases
Objective To study the diagnoses and clinical characteristics of systemic inflammatory response syndrome (SIRS) in critical patients.Methods The clinical data of 72 patients enrolled by ICU and emergency department were studied. The patients met at least two of the criteria for SIRS of ACCP/SCCM with dysfunction of one or more organs.Results 57 (79.2%) of the 72 patients investigated met three or more of the criteria for SIRS,the majority of patients suffered from surgical operations (44.4%) and infections(37.5%),and positive pathogenic organisms were founded in 83.3% of various body samples with 33.3% of positive result in blood culture for 48 patients of 72 cases. 19.4% of th patients developed MODS .With the increasing in the number according to of SIRS criteria , the patients developed gradually in the proportion to the rate of sepsis and MODS.Conclusion It is suggested that severe trauma ,especially bacterial infection be the major cause of SIRS and criteria for SIRS of ACCP/SCCM is quite useful in the evaluation of SIRS.
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Discontinuation
Cortisol awakening response
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Objective To clarify conceptions about severe acute pancreatitis(SAP) and systemic inflammatory response syndrome (SIRS).Methods Sixty patients with SAP were enrolled in this study. Development of SIRS in these patients was examined and discussed in terms of course of disease and cause of death. Results SIRS occurred in 96.7% of the patients and lasted 5.6 ± 3.5 ; Death rate of the cases of SAP complicated with sepsis was significantly higher than that of the other cases ( P 0.05 ), Incidence rate of SAP complicated with sepsis, multiple organ dysfunction syndrome (MODS), multiple system organ failure (MSOF) and death in non operative treatment group was significantly higher than those of operative treatment group ( P 0.05 , P 0.01 , P 0.01 and P 0.05 , respectively). Conclusion The course of SAP would advance into the MODS stage ultimately when inducements which facilitate the development of SIRS can not be controlled or removed effectively. Principle of treatment for SAP includes organ supporting, infection control, correction of circulator and metabolic disturbance and operative treatment at proper moments.
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