Schefzik Roman, Hahn Bianka, Schneider-Lindner Verena
Department of Anesthesiology and Surgical Intensive Care Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Front Med (Lausanne). 2023 Jul 31;10:1227031. doi: 10.3389/fmed.2023.1227031. eCollection 2023.
Sepsis is the leading cause of death in intensive care units (ICUs), and its timely detection and treatment improve clinical outcome and survival. Systemic inflammatory response syndrome (SIRS) refers to the concurrent fulfillment of at least two out of the following four clinical criteria: tachycardia, tachypnea, abnormal body temperature, and abnormal leukocyte count. While SIRS was controversially abandoned from the current sepsis definition, a dynamic SIRS representation still has potential for sepsis prediction and diagnosis.
We retrospectively elucidate the individual contributions of the SIRS criteria in a polytrauma cohort from the post-surgical ICU of University Medical Center Mannheim (Germany).
We used a dynamic and prospective SIRS algorithm tailored to the ICU setting by accounting for catecholamine therapy and mechanical ventilation. Two clinically relevant tasks are considered: (i) sepsis prediction using the first 24 h after admission to our ICU, and (ii) sepsis diagnosis using the last 24 h before sepsis onset and a time point of comparable ICU treatment duration for controls, respectively. We determine the importance of individual SIRS criteria by systematically varying criteria weights when summarizing the SIRS algorithm output with SIRS descriptors and assessing the classification performance of the resulting logistic regression models using a specifically developed ranking score.
Our models perform better for the diagnosis than the prediction task (maximum AUROC 0.816 vs. 0.693). Risk models containing only the SIRS level average mostly show reasonable performance across criteria weights, with prediction and diagnosis AUROCs ranging from 0.455 (weight on leukocyte criterion only) to 0.693 and 0.619 to 0.800, respectively. For sepsis prediction, temperature and tachypnea are the most important SIRS criteria, whereas the leukocytes criterion is least important and potentially even counterproductive. For sepsis diagnosis, all SIRS criteria are relevant, with the temperature criterion being most influential.
SIRS is relevant for sepsis prediction and diagnosis in polytrauma, and no criterion should a priori be omitted. Hence, the original expert-defined SIRS criteria are valid, capturing important sepsis risk determinants. Our prospective SIRS algorithm provides dynamic determination of SIRS criteria and descriptors, allowing their integration in sepsis risk models also in other settings.
脓毒症是重症监护病房（ICU）死亡的主要原因，及时检测和治疗可改善临床结局和生存率。全身炎症反应综合征（SIRS）是指同时满足以下四项临床标准中的至少两项：心动过速、呼吸急促、体温异常和白细胞计数异常。虽然SIRS已从当前的脓毒症定义中被有争议地摒弃，但动态SIRS表现仍具有脓毒症预测和诊断的潜力。
我们回顾性地阐明了德国曼海姆大学医学中心外科重症监护病房多创伤队列中SIRS标准的个体贡献。
我们使用了一种根据ICU环境量身定制的动态前瞻性SIRS算法，该算法考虑了儿茶酚胺治疗和机械通气。考虑两项临床相关任务：（i）使用入住我们ICU后的前24小时进行脓毒症预测，以及（ii）分别使用脓毒症发作前的最后24小时和对照组具有可比ICU治疗持续时间的时间点进行脓毒症诊断。当用SIRS描述符汇总SIRS算法输出时，我们通过系统地改变标准权重来确定各个SIRS标准的重要性，并使用专门开发的排名分数评估所得逻辑回归模型的分类性能。
我们的模型在诊断任务上的表现优于预测任务（最大受试者工作特征曲线下面积[AUROC]为0.816对0.693）。仅包含SIRS水平平均值的风险模型在不同标准权重下大多表现出合理的性能，预测和诊断的AUROC分别为0.455（仅白细胞标准权重）至0.693以及0.619至0.800。对于脓毒症预测，体温和呼吸急促是最重要的SIRS标准，而白细胞标准最不重要，甚至可能适得其反。对于脓毒症诊断，所有SIRS标准都相关，其中体温标准影响最大。
SIRS在多创伤患者的脓毒症预测和诊断中具有相关性，任何标准都不应事先被省略。因此，最初由专家定义的SIRS标准是有效的，可捕捉重要的脓毒症风险决定因素。我们的前瞻性SIRS算法提供了SIRS标准和描述符的动态确定，使其也能在其他环境中整合到脓毒症风险模型中。
