SYSTEMIC INFLAMMATORY RESPONSE SYNDROME, SEPSIS, SEVERE SEPSIS AND SEPTIC SHOCK - INCIDENCE, MORBIDITIES AND OUTCOMES IN SURGICAL ICU PATIENTS

Objectives: To determine the incidence of systemic inflammatory respon se syndrome (SIRS), sepsis and severe sepsis in surgical ICU patients and define patient characteristics associated with their acquisition a nd outcome. Design: One-month prospective study of critically ill pati ents with a 28 day in-hospital follow up. Setting: Surgical intensive care unit (SICU) at a tertiary care institution. Methods: All patients (n = 170) admitted to the SICU between April 1 and April 30, 1992 wer e prospectively followed for 28 days. Daily surveillance was performed by two dedicated, specifically-trained research nurses. Medical and n ursing chart reviews were performed, and follow up information at six and twelve months was obtained. Results: The in-hospital surveillance represented 2246 patient-days, including 658 ICU patient-days. Overall , 158 patients (93%) had SIRS for an incidence of 542 episodes/1000 pa tients-days. The incidence of SIRS in the ICU was even higher (840 epi sodes/1000 patients-days). A total of 83 patients (49%) had sepsis; am ong them 28 developed severe sepsis. Importantly, 13 patients had seve re sepsis after discharge from the ICU. Patient groups were comparable with respect to age, sex ratio, and type of surgery performed. Apache II score on admission to the ICU and ASA score at time of surgery wer e significantly higher (p < 0.05) only for patients who subsequently d eveloped severe sepsis. The crude mortality at 28 days was 8.2% (14/17 0); it markedly differed among patient groups: 6% for those with SIRS vs. 35% for patients with severe sepsis. Patients with sepsis and seve re sepsis had a longer mean length of ICU stay (2.1 +/- 0.2 and 7.5 +/ - 1.5, respectively) than those with SIRS (1.45 +/- 0.1) or control pa tients (1.16 +/- 0.1). Total length of hospital stay also markedly dif fered among groups (35 +/- 9 (severe sepsis), 24 +/- 2 (sepsis), 11 +/ - 0.8 (SIRS), and 9 +/- 0.1 (controls, respectively). Conclusions: Alm ost everyone in the SICU had SIRS. Therefore, because of its poor spec ificity, SIRS was not helpful predicting severe sepsis and septic shoc k. Patients who developed sepsis or severe sepsis had higher crude mor tality and length of stay than those who did not. Studies designed to identify those who develop complications of SIRS would be very useful.