Predicting Mortality of SICU Patients with Intra-Abdominal Sepsis
Sepsis management and diagnosis is very important for ICU patients. A recent study provides another tool to better predict mortality in these patients.
The PIRO Score is based on several factors of the overall patient care picture. It includes predisposition, infection/injury, response, organ dysfunction. PIRO Scores are not new and are utilized with other disease processes. However, this is the first time that PIRO Scores have been applied to surgical patients with intra-abdominal sepsis.
Our ICU patients, as are hospitalized patients in general, sicker then ever. SICU patients can have many co-morbidities prior to the event that landed them in the ICU. We need easy to use scoring tools to determine their care and to help determine possible complications and avert them if possible.
A recent study published in the American Journal of Critical Care, describes the research as data taken from 2005 through 2010 of a prospective observational cohort. "A PIRO score was developed that included the following variables: age greater than 65 years; comorbid conditions; leukopenia; hypothermia; and cardiovascular, renal, respiratory, and central nervous system failure. One point was given for each feature detected. The mean score was significantly higher (P<.001) in nonsurvivors (3.9) than in survivors (2.3). When the data were distributed according to PIRO scores, mortality rate increased (P<.001). The area under the receiver operating characteristic curve indicated consistent mortality discrimination by PIRO scores (0.80; 95% CI, 0.79-0.83), outperforming the Acute Physiology and Chronic Health Evaluation II (0.72; 95% CI, 0.68-0.75) and the Sequential Organ Failure Assessment (0.72; 95% CI, 0.68-0.76) (P<.001). Conclusion The PIRO score is useful for predicting mortality in patients with surgically related intra-abdominal sepsis. (American Journal of Critical Care. 2018;27:287-294)"
We are all familiar with other scoring systems such as APACHE, SOFA and other hospital-specific scores to predict mortality. However, the PIRO criteria is simpler, uses only 8 variables and is easy to use bedside.
Age seems to be the strongest determining factor in survivability of sepsis. There are several reasons for this:
- The immune system decreases as we age, thus opening the way for sepsis
- Pneumonia which can be a causative diagnosis to sepsis increases in frequency as age increases
Another risk factor for mortality in sepsis is hypothermia though the causation of this is not well known. It is theorized that Yet another risk factor is leukopenia especially as it relates to pneumococcal bacteremia and ETOH abuse.
The full research study is available here.
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