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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

2013-01-18Artigo científico Acesso aberto
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dc.contributor.authorGranja, Cristina
dc.contributor.authorPóvoa, Pedro
dc.contributor.authorPovoa, Pedro
dc.contributor.authorLobo, Cristina
dc.contributor.authorTeixeira-Pinto, Armando M.
dc.contributor.authorCarneiro, António
dc.contributor.authorda Costa Pereira, Altamiro
dc.contributor.institutionNOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM)
dc.contributor.institutionCentro de Estudos de Doenças Crónicas (CEDOC)
dc.contributor.pblPLOS - Public Library of Science
dc.date.accessioned2017-08-02T22:05:27Z
dc.date.available2017-08-02T22:05:27Z
dc.date.issued2013-01-18
dc.descriptionCristina 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.
dc.description.abstractIntroduction: 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.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent252725
dc.identifier.doi10.1371/journal.pone.0053885
dc.identifier.issn1932-6203
dc.identifier.otherPURE: 2988366
dc.identifier.otherPURE UUID: aad45fd0-b55c-4342-9940-bec16eeedb99
dc.identifier.otherScopus: 84872591132
dc.identifier.otherPubMed: 23349756
dc.identifier.otherWOS: 000313872800017
dc.identifier.urihttp://www.scopus.com/inward/record.url?scp=84872591132&partnerID=8YFLogxK
dc.identifier.urlhttps://www.scopus.com/pages/publications/84872591132
dc.language.isoeng
dc.peerreviewedyes
dc.relationinfo:eu-repo/grantAgreement/FCT/5876-PPCDTI/83312/PT
dc.subjectCOMMUNITY-ACQUIRED PNEUMONIA
dc.subjectINTENSIVE-CARE UNITS
dc.subjectVENTILATOR-ASSOCIATED PNEUMONIA
dc.subjectPRACTICE GUIDELINES
dc.subjectNORTHERN-IRELAND
dc.subjectSEPTIC SHOCK
dc.subjectEPIDEMIOLOGY
dc.subjectMANAGEMENT
dc.subjectSCORE
dc.subjectDYSFUNCTION
dc.subjectGeneral Medicine
dc.subjectGeneral Biochemistry,Genetics and Molecular Biology
dc.subjectGeneral Agricultural and Biological Sciences
dc.subjectSDG 3 - Good Health and Well-being
dc.titleThe Predisposition, Infection, Response and Organ Failure (Piro) Sepsis Classification System: Results of Hospital Mortality Using a Novel Concept and Methodological Approachen
dc.typejournal article
degois.publication.issue1
degois.publication.titlePLoS ONE
degois.publication.volume8
dspace.entity.typePublication
oaire.awardNumber83312
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/5876-PPCDTI/83312/PT
oaire.fundingStream5876-PPCDTI
person.familyNamePovoa
person.givenNamePedro
person.identifier.ciencia-id0C16-5CF9-9238
person.identifier.orcid0000-0002-7069-7304
person.identifier.scopus-author-id6602772147
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccess
relation.isAuthorOfPublication04ec38ba-be1e-46e5-8007-0e65a557d0f4
relation.isAuthorOfPublication.latestForDiscovery04ec38ba-be1e-46e5-8007-0e65a557d0f4
relation.isProjectOfPublication1fb091cb-5ab9-4d51-aa4c-cc9ef4be81af
relation.isProjectOfPublication.latestForDiscovery1fb091cb-5ab9-4d51-aa4c-cc9ef4be81af

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