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Correspondence |

Naming and Blaming, SIRS-UO FREE TO VIEW

Matijs van Meurs, PhD; Jack J.M. Ligtenberg, PhD; Jan G. Zijlstra, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDepartment of Critical Care, University of Groningen, Groningen, The Netherlands

bDepartment of Emergency Medicine, University of Groningen, Groningen, The Netherlands

CORRESPONDENCE TO: Jan G. Zijlstra, PhD, University Medical Center Groningen, University of Groningen, 9700RB, Hanzeplein 1, Groningen, The Netherlands


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(3):723-724. doi:10.1016/j.chest.2016.10.062
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In a recent issue (December 2016) of CHEST, Gupta et al clearly describe the epidemiology of culture negative severe sepsis (CNSS). Sepsis is defined as systemic inflammatory response syndrome (SIRS) in the presence of proven or suspected infection. However in 40% to 50% of patients, cultures are negative., Most clinicians will not be surprised by these data. SIRS criteria are met by many critically ill patients. Severe pancreatitis; major trauma; severe hemorrhage; major surgery; infections with viral, fungal, or bacterial pathogens; and autoimmune diseases all can elicit SIRS symptoms. If we cannot detect 1 of these causes, it is convenient to blame an unidentified pathogen and call it CNSS. It is an ancient human habit to give something a name and then feel master of it. (Genesis 2-19: Now the LORD God had formed out of the ground all the wild animals and all the birds in the sky. He brought them to the man to see what he would name them; and whatever the man called each living creature, that was its name.)

All the attention for sepsis may have led to framing in the direction of infection,; however, although not consistent, there are differences found between the negative and positive cohort involving comorbidity, severity of illness, and outcome., This suggests that the etiology also might be different and not solely related to undetected infection. In fact, we do not know the etiology of CNSS. The unjustified feeling of confidence because we think we know what we are dealing with might lead to diagnostic and research slackness.

We therefor plea to rename CNSS to SIRS-UO: systemic inflammatory response syndrome of unknown origin.

References

Gupta S. .Sakhuja A. .Kumar G. .McGrath E. .Nanchal R.S. .Kashani K.B. . Culture-negative severe sepsis: nationwide trends and outcomes. Chest. 2016;150:1251-1259 [PubMed]journal. [CrossRef] [PubMed]
 
Levy M.M. .Fink M.P. .Marshall J.C. .et al 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intens Care Med. 2003;29:530-538 [PubMed]journal. [CrossRef]
 
Phua J. .Ngerng W. .See K. .et al Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit Care. 2013;17:R202- [PubMed]journal. [CrossRef] [PubMed]
 
Rivers E. .Nguyen B. .Havstad S. .et al Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-1377 [PubMed]journal. [CrossRef] [PubMed]
 
Dellinger R.P. .Levy M.M. .Rhodes A. .et al Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580-637 [PubMed]journal. [CrossRef] [PubMed]
 

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References

Gupta S. .Sakhuja A. .Kumar G. .McGrath E. .Nanchal R.S. .Kashani K.B. . Culture-negative severe sepsis: nationwide trends and outcomes. Chest. 2016;150:1251-1259 [PubMed]journal. [CrossRef] [PubMed]
 
Levy M.M. .Fink M.P. .Marshall J.C. .et al 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intens Care Med. 2003;29:530-538 [PubMed]journal. [CrossRef]
 
Phua J. .Ngerng W. .See K. .et al Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit Care. 2013;17:R202- [PubMed]journal. [CrossRef] [PubMed]
 
Rivers E. .Nguyen B. .Havstad S. .et al Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368-1377 [PubMed]journal. [CrossRef] [PubMed]
 
Dellinger R.P. .Levy M.M. .Rhodes A. .et al Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580-637 [PubMed]journal. [CrossRef] [PubMed]
 
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