THE NATURAL-HISTORY OF THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS) - A PROSPECTIVE-STUDY
THE NATURAL-HISTORY OF THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS) - A PROSPECTIVE-STUDY
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DOI：
10.1001/jama.273.2.117
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发表时间：
1995-01-11
影响因子：
120.7
通讯作者：
WENZEL, RP
中科院分区：
文献类型：
--
作者：
RANGELFRAUSTO, MS;PITTET, D;WENZEL, RP
目标。定义最近分类的描述感染生物学反应的四种综合征的流行病学：全身性炎症反应综合征（SIRS）、败血症、严重败血症和感染性休克。前瞻性队列研究，随访28天，如果更早，随访至出院。-三级保健机构的3个重症监护病房和3个普通病房。如果患者符合至少两项SI RS的标准：发热或体温过低、心动过速、呼吸急促或白细胞计数异常。主要结果测量。-发生任何阶段的感染生物反应：败血症、严重败血症、感染性休克、终末器官功能障碍和死亡。在研究期间，3708例患者被纳入调查单元，2527例（68%）符合SIRS标准。SIRS在外科、内科和心血管重症监护病房的发病率密度分别为每1000患者日857,804和542例，在内科、心胸外科和普通外科病房的发病率密度分别为每1000患者日671,495和320例。SIRS患者中，649例（26%）发生脓毒症，467例（18%）发生严重脓毒症，110例（4%）发生脓毒症休克。从SIRS到脓毒症的中位间隔与患者满足SIRS标准（2项、3项或全部4项）的数量呈负相关。随着SIRS患者向感染性休克发展，出现成人呼吸窘迫综合征、弥散性血管内凝血、急性肾功能衰竭和休克的比例越来越高。17%的脓毒症患者、25%的严重脓毒症患者和69%的脓毒症休克患者的血培养呈阳性。SIRS、脓毒症、严重脓毒症和脓毒症休克的死亡率也呈阶梯上升：分别为7%、16%、20%和46%。有趣的是，我们还观察到了同样数量的脓毒症、严重脓毒症和脓毒性休克患者，但他们的培养结果为阴性。在这些培养阴性人群中，全身性炎症反应的原因尚不清楚，但他们的发病率和死亡率与相应的培养阳性人群相似。据我们所知，这项SIRS及相关疾病的前瞻性流行病学研究首次提供了从SIRS到脓毒症到严重脓毒症和脓毒症休克的临床进展的证据。
Objective.-Define the epidemiology of the four recently classified syndromes describing the biologic response to infection: systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, and septic shock.Design.-Prospective cohort study with a follow-up of 28 days or until discharge if earlier.Setting.-Three intensive care units and three general wards in a tertiary health care institution.Methods.-Patients were included if they met at least two of the criteria for SI RS: fever or hypothermia, tachycardia, tachypnea, or abnormal white blood cell count.Main Outcomes Measures.-Development of any stage of the biologic response to infection: sepsis, severe sepsis, septic shock, end-organ dysfunction, and death.Results.-During the study period 3708 patients were admitted to the survey units, and 2527 (68%) met the criteria for SIRS. The incidence density rates for SIRS in the surgical, medical, and cardiovascular intensive care units were 857, 804, and 542 episodes per 1000 patient-days, respectively, and 671, 495, and 320 per 1000 patient-days for the medical, cardiothoracic, and general surgery wards, respectively. Among patients with SIRS, 649 (26%) developed sepsis, 467 (18%) developed severe sepsis, and 110 (4%) developed septic shock. The median interval from SIRS to sepsis was inversely correlated with the number of SIRS criteria (two, three, or all four) that the patients met. As the population of patients progressed from SIRS to septic shock, increasing proportions had adult respiratory distress syndrome, disseminated intravascular coagulation, acute renal failure, and shock. Positive blood cultures were found in 17% of patients with sepsis, in 25% with severe sepsis, and in 69% with septic shock, There were also stepwise increases in mortality rates in the hierarchy from SIRS, sepsis, severe sepsis, and septic shock: 7%, 16%, 20%, and 46%, respectively. Of interest, we also observed equal numbers of patients who appeared to have sepsis, severe sepsis, and septic shock but who had negative cultures. They had been prescribed empirical antibiotics for a median of 3 days, The cause of the systemic inflammatory response in these culture-negative populations is unknown, but they had similar morbidity and mortality rates as the respective culture-positive populations.Conclusions.-This prospective epidemiologic study of SIRS and related conditions provides, to our knowledge, the first evidence of a clinical progression from SIRS to sepsis to severe sepsis and septic shock.