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An Analysis of a Cohort of Surgical-Related Intraabdominal Sepsis With PIRO FREE TO VIEW

Juan Posadas-Calleja, MD; Thomas Stelfox, PhD; Andre Ferland, MD; Christopher Doig, MS
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University of Calgary, Calgary, AB, Canada

Chest. 2013;144(4_MeetingAbstracts):419A. doi:10.1378/chest.1702264
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Definition and classification of septic patients is challenging. The PIRO concept is a promising hypothesis generating classification scheme for sepsis. We conducted the study to assess the performance of the PIRO concept in a group of surgical patients who were admitted into the ICU with severe sepsis/septic shock from intra-abdominal source.

METHODS: Retrospective analysis of a prospective observational cohort of patients admitted to the adult ICU’s within the Calgary Health Region from the operating room with a diagnosis of severe sepsis/septic shock from intra-abdominal source proven or suspected, between 2005 and 2010.

RESULTS: 905 patients were analyzed. The overall ICU mortality rate was 21.3%, but patients with septic shock experienced a mortality of 40%. Using the PIRO framework, variables were grouped within the Predisposition (age, sex, comorbidities) Infection (bacteremia, type of infection, resistant microorganisms) Response (SIRS criteria) and Organ dysfunction (SOFA score) categories. Those variables in each PIRO subset that reached a p-value of ≤ 0.1 were entered into a stepwise backward elimination logistic regression. A PIRO score was developed including the following variables: age > 65 years, comorbidities, leukopenia, hypothermia, cardiovascular, renal, respiratory, and CNS failure, one point was given for each present feature. The mean PIRO score was significantly higher in nonsurvivors than in survivors (3.9 vs. 2.3 respectively, p < 0.0001). When the patients were distributed according PIRO scoring, mortality rate increased (p < 0.0001). The aROC showed consistent mortality discrimination by PIRO score (0.80, 95%CI 0.79 to 0.83), outperforming APACHE II (0.72, 95%CI 0.68 to 0.75) and SOFA (0.72, 95%CI 0.68 to 0.76) p <0.0001.

CONCLUSIONS: The PIRO score performed well as an ICU mortality predictor tool for surgical-related intra-abdominal sepsis, and outperformed APACHE II and SOFA.

CLINICAL IMPLICATIONS: Our PIRO model can be use to stratify patients for inclusion into a severe sepsis trial. As this model is reviewed and refined over time, it could be used as the TNM system to determine prognosis and ideally individual treatment recommendations for an individual patient suffering from severe sepsis.

DISCLOSURE: The following authors have nothing to disclose: Juan Posadas-Calleja, Thomas Stelfox, Andre Ferland, Christopher Doig

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