How a 4-part system can help classify sepsis severity

For patients who develop intra-abdominal sepsis after surgery, a classification system that scores the variables linked to mortality rates for the infection could help guide care and improve patient outcomes.

A study in the American Journal of Critical Care found that a scoring system based on predisposition, infection/injury type, response and organ dysfunction has helped to predict mortality in surgical intensive care patients with severe sepsis or septic shock due to an intra-abdominal source.

Researchers have previously developed PIRO scores for patients with severe sepsis, ventilator-associated pneumonia and other conditions, but this study is the first to evaluate the usefulness of a PIRO score for surgically related intra-abdominal sepsis.

To develop the PIRO score, the research team analyzed data gathered from 2005 through 2010 from over 1,000 critically ill adult patients diagnosed with abdominal sepsis. These patients were admitted directly to an intensive care unit at three hospitals in Canada. During the study period, 905 patients met the study criteria.

After the researchers identified variables with statistical significance, they created a multivariate PIRO model and evaluated how it could be used as a clinical prediction score. The research team found the resulting PIRO score was a more accurate indicator of mortality for these patients than existing, more data-intensive tools, including the Acute Physiology and Chronic Health Evaluation II and the Sequential Organ Failure Assessment.

The PIRO score consisted of eight variables, weighted equally:

  • Age greater than 65 years
  • Comorbid conditions, such as end-stage renal disease, lung disease or immunosuppression
  • Leukopenia
  • Hypothermia
  • Cardiovascular dysfunction
  • Respiratory dysfunction
  • Renal dysfunction
  • Central nervous system dysfunction

On a scale of zero to 8, the mean PIRO score for all patients in the study was 2.9, with higher mean scores for nonsurvivors (3.9) than for survivors (2.3). Additionally, the researchers found mortality increased as the PIRO score increased.

"Healthcare providers may be able to accurately and quickly predict mortality risk in surgical ICU patients by using a small card with our PIRO rating scale," said co-author Juan G. Posadas-Calleja, MD, clinical associate professor, whose master's thesis served as the impetus for the study.

More articles on clinical leadership and infection control: 
Intermediate hospital occupancy linked to higher C. diff rates, study finds
10 recent findings on antibiotic stewardship and resistance
Penicillin allergy indicates higher risk of developing MRSA, C. diff

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