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The Predisposition, Infection, Response and Organ Failure (Piro) Sepsis Classification System: Results of Hospital Mortality Using a Novel Concept and Methodological Approach
Orientador(es)
Resumo(s)
Introduction: PIRO is a conceptual classification system in which a number of demographic, clinical, biological and laboratory variables are used to stratify patients with sepsis in categories with different outcomes, including mortality rates. Objectives: To identify variables to be included in each component of PIRO aiming to improve the hospital mortality prediction. Methods: Patients were selected from the Portuguese ICU-admitted community-acquired sepsis study (SACiUCI). Variables concerning the R and O component included repeated measurements along the first five days in ICU stay. The trends of these variables were summarized as the initial value at day 1 (D1) and the slope of the tendency during the five days, using a linear mixed model. Logistic regression models were built to assess the best set of covariates that predicted hospital mortality. Results: A total of 891 patients (age 60±17 years, 64% men, 38% hospital mortality) were studied. Factors significantly associated with mortality for P component were gender, age, chronic liver failure, chronic renal failure and metastatic cancer; for I component were positive blood cultures, guideline concordant antibiotic therapy and health-care associated sepsis; for R component were C-reactive protein slope, D1 heart rate, heart rate slope, D1 neutrophils and neutrophils slope; for O component were D1 serum lactate, serum lactate slope, D1 SOFA and SOFA slope. The relative weight of each component of PIRO was calculated. The combination of these four results into a single-value predictor of hospital mortality presented an AUC-ROC 0.84 (IC95%:0.81-0.87) and a test of goodness-of-fit (Hosmer and Lemeshow) of p = 0.368. Conclusions: We identified specific variables associated with each of the four components of PIRO, including biomarkers and a dynamic view of the patient daily clinical course. This novel approach to PIRO concept and overall score can be a better predictor of mortality for patients with community-acquired sepsis admitted to ICUs.
Descrição
Cristina Lobo was financially supported by the Grant from Fundacao para a Ciencia e Tecnologia (PIC/IC/83312/2007). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Palavras-chave
COMMUNITY-ACQUIRED PNEUMONIA INTENSIVE-CARE UNITS VENTILATOR-ASSOCIATED PNEUMONIA PRACTICE GUIDELINES NORTHERN-IRELAND SEPTIC SHOCK EPIDEMIOLOGY MANAGEMENT SCORE DYSFUNCTION General Medicine General Biochemistry,Genetics and Molecular Biology General Agricultural and Biological Sciences SDG 3 - Good Health and Well-being