0
Articles |

Prediction of Mortality in Febrile Medical Patients : How Useful Are Systemic Inflammatory Response Syndrome and Sepsis Criteria?

Ailko W.J. Bossink; A. B. Johan Groeneveld; C. Erik Hack; Lambertus G. Thijs
Author and Funding Information

Affiliations: From the Medical Intensive Care Unit of the Department of Internal Medicine, and the Institute for Cardiovascular Research at the Vrije Universiteit, Amsterdam, the Netherlands,  From the Free University Hospital, the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, and the Institute for Cardiovascular Research at the Vrije Universiteit, Amsterdam, the Netherlands

Affiliations: From the Medical Intensive Care Unit of the Department of Internal Medicine, and the Institute for Cardiovascular Research at the Vrije Universiteit, Amsterdam, the Netherlands,  From the Free University Hospital, the Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, and the Institute for Cardiovascular Research at the Vrije Universiteit, Amsterdam, the Netherlands


1998 by the American College of Chest Physicians


Chest. 1998;113(6):1533-1541. doi:10.1378/chest.113.6.1533
Text Size: A A A
Published online

Abstract

Study objectives: The aim was to evaluate demographic, clinical, and laboratory variables in febrile patients, with or without a microbiologically confirmed infection, for prediction of death, in comparison to the systemic inflammatory response syndrome (SIRS) and its criteria, such as abnormal temperature, tachycardia, tachypnea, and abnormal WBC count, and to sepsis, that includes SIRS and an infection.

Design: A prospective cohort study.

Setting: Department of internal medicine at a university hospital.

Patients: In 300 consecutive, hospitalized medical patients with new onset of fever, demographic, clinical, and laboratory variables were obtained during the 2 days after inclusion, while microbiological results for a follow-up period of 7 days were collected. Patients were followed up for survival or death, up to a maximum of 28 days after inclusion.

Measurements and results: Of all patients, 95% had SIRS, 44% had sepsis with a microbiologically confirmed infection, and 9% died. A model with a set of variables all significantly (p<0.01) contributing to the prediction of mortality was derived. The set included the presence of hospital-acquired fever, the peak respiratory rate, the nadir score on the Glasgow coma scale, and the nadir albumin plasma level within the first 2 days after inclusion. This set of variables predicted mortality for febrile patients with microbiologically confirmed infection even better. The predictive values for mortality of SIRS and sepsis were less than that of our set of variables.

Conclusions: In comparison to SIRS and sepsis, the new set of variables predicted mortality better for all patients with fever and also for those with microbiologically confirmed infection only. This type of effort may help in refining definitions of SIRS and sepsis, based on prognostically important demographic, clinical, and laboratory variables that are easily obtainable at the bedside.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
Diagnostic laparoscopy in the ICU. In: Diagnostic laparoscopy guidelines.
Society of American Gastrointestinal and Endoscopic Surgeons | 4/10/2009
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543