THE SIGNIFICANCE OF THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME (SIRS) IN 1278 TRAUMA PATIENTS

The association between the increasing severity of systemic inflammato ry response syndrome (SIRS) and the incidence of posttraumatic complic ations and mortality was retrospectively investigated in 1278 injured patients. Patients were divided into three groups according to their I njury Severity Score (ISS) (group A: ISS greater than or equal to 9 le ss than or equal to 16 points (n = 626); group B: ISS > 16 < 40 points (n = 589); group C: ISS greater than or equal to 40 points (n = 63)). SIRS was defined according to the criteria of the American Consensus Conference. The number of fulfilled criteria determined its severity: moderate SIRS: 2 criteria fulfilled, intermediate SIRS: 3 criteria ful filled, severe SIRS: 4 criteria fulfilled. Additionally, acute respira tory distress syndrome (ARDS) was defined according to the Murray-Scor e and the multiple organ dysfunction syndrome (MODS) according to the Goris-Score. The incidence of SIRS was 42% in group A, 70% in group B and 100% in group C (p < 0.05). The severity of SIRS increased with se verity of trauma. Moreover, 178 of all injured patients (14%) develope d septic complications. In parallel to SIRS, the incidence of these se ptic complications correlated with the severity of trauma. The occurre nce and severity of ARDS and MODS correlated with increased severity o f SIRS and septic complications. Among patients without SIRS 15% devel oped ARDS and 21% MODS. In contrast, patients with severe SIRS and sep tic complications demonstrated ARDS in 99% and MODS in 97%. In these p atients, no correlation was found between the ISS and the incidence of ARDS or MODS. There were also stepwise increases in mortality rates i n the hierarchy from SIRS to septic shock. While 13 of patients with m odest SIRS (5%) and 32 of patients with intermediate SIRS (13%) died, the mortality rate of patients with severe SIRS was 19% (p < 0.05). In addition, a significant correlation between the incidence of septic c omplications and mortality was found. Injured patients with sepsis die d in 13%, those with severe sepsis in 23%, and patients with septic sh ock in 33 % (p < 0.05). Thus, the increasing severity of SIRS was asso ciated with the occurrence of posttraumatic ARDS, MODS, and mortality. Using the number of fulfilled SIRS criteria for classifying systemic inflammation, its severity may be predictive for posttraumatic complic ations and outcome of injured patients.