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PubMed1998

Time course of immunological markers in patients with the systemic inflammatory response syndrome: evaluation of sCD14, sVCAM-1, sELAM-1, MIP-1 alpha and TGF-beta 2.

BACKGROUND: The systemic inflammatory response syndrome (SIRS) is viewed as a system-wide inflammatory response. Up until now, no parameter has been available for predicting the development of septic shock. In the present study, we evaluated the usefulness of serum levels of CD14, vascular cells adhesion molecule-1 (VCAM-1), endothelial leucocyte adhesion molecule-1 (ELAM-1), macrophage inflammatory protein (MIP) 1 alpha and transforming growth factor beta 2 (TGF-beta 2) as early markers of outcome in patients with SIRS. METHODS: A group of 28 SIRS patients (13 survivors/15 non-survivors) was compared with a healthy control group and with patients with local inflammation. Blood samples were analysed on days 0, 4 and 7. Proinflammatory parameters such as sCD14, sVCAM-1, sELAM-1, MIP-1 alpha and anti-inflammatory parameters such as TGF-beta 2 were determined using enzyme-linked immunosorbent assay (ELISA). RESULTS: At the beginning, all evaluated proinflammatory immunological parameters with the exception of sVCAM-1 were significantly increased in patients with SIRS compared with the healthy control group. However, no significant difference could be observed for all immunological parameters comparing survivors and non-survivors, with the exception of interleukin (IL) 6 at day 7. CONCLUSION: All evaluated proinflammatory parameters were increased in patients with SIRS during the course of the disease. However, the parameters have no correlation with outcome and prognosis of SIRS patients.

Adult↗
PubMed2001

Recombinant bactericidal/permeability-increasing protein attenuates the systemic inflammatory response syndrome in lower limb ischemia-reperfusion injury.

OBJECTIVES: Hind limb ischemia-reperfusion (I/R) injury increases gut permeability, and resultant endotoxemia is associated with an amplified systemic inflammatory response syndrome leading to multiple organ dysfunction syndrome. We studied the potential role of recombinant bactericidal/permeability-increasing protein (rBPI(21) ), a novel antiendotoxin therapy, in modulating endotoxin-enhanced systemic inflammatory response syndrome in hind limb I/R injury. METHODS: In this prospective, randomized, controlled, experimental animal study, 48 male Wistar rats, weighing 300 to 350 g, were randomized to a control group (sham) and five groups undergoing 3 hours bilateral hind limb ischemia with 2 hours reperfusion (I/R) (n = 8 per group). The control and untreated I/R groups received thaumatin, a control-protein preparation, at 2 mg/kg. Treatment groups were administered rBPI(21) intravenously at 1, 2, or 4 mg/kg body weight at the beginning of reperfusion; an additional group was administered rBPI(21) intravenously at 2 mg/kg after 1 hour of reperfusion. Plasma interleukin-6 concentration was estimated by bioassay as a measure of systemic inflammation. Plasma endotoxin concentration was determined by use of an amebocyte lysate chromogenic assay. Crossreactive immunoglobulin G and M antibodies to the highly conserved inner core region of endotoxin were measured by use of an enzyme-linked immunosorbent assay. The lung tissue wet-to-dry weight ratio and myeloperoxidase concentration were used as markers of edema and neutrophil sequestration, respectively. RESULTS: I/R provoked highly significant elevation in plasma interleukin-6 concentrations (1351.20 pg/mL [860.16 - 1886.40 pg/mL]) compared with controls (125.32 pg/mL [87.76-157.52 pg/mL; P <.0001]), but treatment with rBPI(21) 2 mg/kg at onset of reperfusion (715.89 pg/mL [573.36-847.76 pg/mL]) significantly decreased interleukin-6 response compared with the nontreatment group ( P <.016). I/R increased plasma endotoxin concentrations significantly (21.52 pg/mL [6.20-48.23 pg/mL]), compared with control animals (0.90 pg/mL [0.00-2.30 pg/mL; P <.0001]), and treatment with rBPI(21) 4 mg/kg at reperfusion significantly decreased endotoxemia (1.30 pg/mL [1.20-2.20 pg/mL]), compared with the untreated group ( P <.001). The lung tissue myeloperoxidase level was significantly increased in the untreated I/R group (208.18% [128.79%-221.81%]), compared with in controls (62.00% [40.45%-80.92%; P <.0001]), and attenuated in those treated with rBPI(21) 2 mg/kg (129.54% [90.49%-145.78%; P <.05]). Data represent median and interquartile range, comparisons made with the nonparametric Mann-Whitney U test. CONCLUSIONS: These findings show that hind limb ischemia-reperfusion injury is associated with endotoxemia, elevations in plasma interleukin-6, and pulmonary leukosequestration. Treatment with rBPI(21) after ischemia reduces endotoxemia, the interleukin-6 response, and attenuates pulmonary leukosequestration in response to hind limb reperfusion injury.

Animals↗
PubMed1998

[Significance of systemic inflammatory response syndrome after surgical treatment for thoracic esophageal cancer].

We studied the significance of Systemic Inflammatory Response Syndrome (SIRS) state after surgical treatment of thoracic esophageal cancer. From January 1991 to December 1995, 35 patients received thoracic esophageal cancer surgery. Thirty three patients (94.3%) were in the SIRS state after surgery and mean duration of SIRS was 3.4 days. Duration of SIRS was statistically longer in patients with pulmonary complications. Patients with hyperbilirubinemia (> or = 3.0 mg/dl) after surgery had longer duration of SIRS. Induction therapy did not affect the duration of SIRS. Collectively, duration of SIRS is an indication of complications, especially of pulmonary complications, after surgical treatment of thoracic esophageal cancer, and blood bililubin score after surgery correlates to duration of SIRS. These suggest that we must pay special attention to patients with long duration of SIRS or hyperbilirubinemia after thoracic esophageal surgery.

Aged↗
PubMed1996

The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis.

Criteria defining the systemic inflammatory response syndrome (SIRS) were used to assess prospectively 270 clinical episodes in which blood cultures were taken from patients in general medicine. SIRS, severe sepsis and septic shock occurred in 149 (55%), 13 (5%) and 9 (3%) episodes, respectively. However, evidence of organ hypoperfusion indicating severe sepsis was recorded as sought in only 26% of episodes of SIRS. Crude mortality at 28 days increased sequentially as more SIRS criteria were met, rising from 12% in non-SIRS blood culture episodes, to 36% when all four criteria were met. Mortality from severe sepsis and septic shock was 38% and 56%, respectively. In 61/64 (95%) episodes of clinically important bacteraemia, patients fulfilled SIRS criteria when the blood culture was taken. However, the positive predictive value of SIRS for predicting bacteraemia was only 7%. Patients who did not fulfil SIRS criteria when blood cultures were taken were at low risk of bacteraemia and comprised 45% (121/270) of the study population. Three patients in this low-risk group had bacteraemia. Mortality in bacteraemic patients with severe sepsis or septic shock who were initially treated with ineffective antibiotics for up to 48 h was 80%, compared to 42% in those always treated appropriately.

Adolescent↗
PubMed2005

[Investigation on the relation between systemic inflammatory response syndrome and severity of acute pancreatitis].

OBJECTIVE: To explore the relationship between the systemic inflammatory response syndrome (SIRS) and the severity of the acute pancreatitis, so as to provide some leads in the treatment to lower the mortality of severe acute pancreatitis. METHODS: One hundred and seventy-two patients suffering from acute pancreatitis admitted to our departments from January 1, 2001 to December 31, 2003 were retrospectively analyzed. The patients were divided into survivor group and non-survivor group, and patients in the survivor group were further divided into severe group and mild group according to scores of acute physiology and chronic health evaluation II (APACHE II). The scores of APACHE II were compared between patients without SIRS and those who met the criteria of SIRS. RESULTS: There was significant difference between the survivor group and non-survivor group not only in the incidence of patients who developed SIRS, but also in the number of patients fulfilling or not fulfilling the diagnostic criteria of SIRS between the severe group and mild group. There was also significant statistical difference between the SIRS group and non-SIRS group in the APACHE II scoring. Significant difference in duration of SIRS was found between the severe group and mild group. CONCLUSION: SIRS is highly correlated with the severity of acute pancreatitis. Active prevention and treatment of SIRS may raise the survival rate of severe acute pancreatitis.

APACHE↗
PubMed2004

Influence of systemic inflammatory response syndrome on host resistance against bacterial infections.

OBJECTIVE: To determine the relationship between systemic inflammatory response syndrome (SIRS) and host innate immunities against bacterial infections. DESIGN: Controlled animal study. SETTING: University research laboratory. SUBJECTS: Male BALB/c mice, 8-10 wks of age. INTERVENTIONS: Morbidity and mortality rates of severe SIRS mice were compared with those of mild SIRS mice after infection with Enterococcus faecalis or methicillin-resistant Staphylococcus aureus (MRSA) or exposure to infectious complications induced by cecal ligation and puncture (CLP). In addition, a function of effector cells related to antibacterial innate immunities for these infections was analyzed in these two groups. Furthermore, SCIDbgMN mice (SCIDbg mice depleted of antibacterial effector cells) were reconstituted with effector cells from mild or severe SIRS mice and exposed to various infections. MEASUREMENTS AND MAIN RESULTS: Severe SIRS mice were greatly susceptible to E. faecalis, MRSA, and CLP-induced sepsis. On the other hand, as compared with normal mice, mild SIRS mice were resistant to these infections. All of SCIDbgMN mice inoculated with peritoneal macrophages (PMphi) from severe SIRS mice died after infection with E. faecalis or MRSA, whereas all SCIDbgMN mice inoculated with PMphi from mild SIRS mice survived after the same infection. SCIDbgMN mice that were inoculated with PMphi from normal mice and exposed to E. faecalis, MRSA, or CLP survived at rates of 50%, 50%, or 60%, respectively. PMphi from mild SIRS mice exhibited typical properties for classically activated macrophages (CAMphi), whereas those from severe SIRS mice exhibited typical properties for alternatively activated macrophages (AAMphi). CONCLUSIONS: Mphi-associated host antibacterial innate immunities are greatly influenced by SIRS levels. CAMphi, effector cells for the antibacterial innate immunity against E. faecalis, MRSA, and CLP-induced sepsis, are induced in mild SIRS mice. AAMphi with no antibacterial capabilities are generated in mice with severe SIRS. Induction of CAMphi may protect severe SIRS patients against infections.

Analysis of Variance↗
PubMed1998

Diffusive vs. convective therapy: effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome.

OBJECTIVE: To compare two forms of continuous renal replacement therapy, continuous venovenous hemofiltration (CVVH) vs. continuous venovenous hemodialysis (CVVHD), in terms of the removal of inflammatory mediators from the blood of patients with systemic inflammatory response syndrome and acute renal failure. DESIGN: Randomized crossover, clinical study. SETTING: University teaching hospital. PATIENTS: Thirteen patients with systemic inflammatory response syndrome and acute renal failure receiving continuous renal replacement therapy. INTERVENTION: Patients were randomized to receive either convective clearance using CVVH or diffusive clearance using CVVHD for the first 24 hrs, followed by the other modality for 24 hrs. All treatments utilized AN69 hemofilters. CVVH was performed with an ultrafiltration rate of 2 L/hr and CVVHD with a dialysis outflow rate of 2 L/hr. MEASUREMENTS AND MAIN RESULTS: Plasma and ultrafiltrate concentrations of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, and sL-selectin were measured at 0, 1, 3, 6, 12, and 24 hrs by radioimmunoassay. Plasma endotoxin concentrations were also measured at 0, 12, and 24 hrs by chromogenic assay. CVVH was associated with a 13% decrease in plasma TNF-alpha concentrations compared with a 23% increase while on CVVHD (p < .05). Mean plasma concentrations of IL-6, IL-10, and sL-selectin were unchanged over time and between therapies. Only minimal amounts of mediators were recovered in the effluents with either therapy except for IL-6. The clearances for IL-6 were different between therapies, 1.9+/-0.8 (SD) mL/min for CVVHD and 3.3+/-1.5 mL/min for CVVH, (p< .01). Plasma endotoxin concentrations were not different between therapies. CONCLUSION: CVVH resulted in a decrease in plasma TNF-alpha concentrations as compared with CVVHD, while the type of transport mechanism used did not influence plasma concentrations of IL-6, IL-10, soluble L-selectin, or endotoxin. Differences in clearance for IL-6 between CVVH and CVVHD did not translate into significant changes in circulating IL-6 concentrations.

Acute Kidney Injury↗
PubMed1996

Blockade of transdiaphragmatic lymphatic absorption reduced systemic inflammatory response syndrome during experimental peritonitis: evaluation with body oxygen kinetics in rats.

OBJECTIVE: To assess the effect of blockade of transdiaphragmatic lymphatic absorption of infected peritoneal fluid on systemic inflammatory response syndrome during experimental peritonitis by evaluating body oxygen kinetics in rats. DESIGN: Randomised controlled experimental study. SETTING: Teaching hospital, Turkey. MATERIAL: 30 Wistar-albino rats, 10 in each group. INTERVENTIONS: Control group, sham laparotomy; peritonitis alone group, faecal peritonitis induced by caecal puncture; and lymphatic blockade and peritonitis group, transdiaphragmatic lymphatic absorption was blocked by fibrosis created by a sheet of braided polyester (Mersilene) mesh, and peritonitis induced with caecal puncture. MAIN OUTCOME MEASURES: Aerobic culture of peritoneal contents and blood. Arterial and mixed venous blood gas analysis, plasma lactate concentrations. Indicators of body oxygen kinetics were calculated from these variables. RESULTS: Bacterial peritonitis was detectable in all 20 animals in the experimental groups. Blood cultures grew pathogens in 9/10 animals in the peritonitis alone group and 4/10 in the lymphatic blockade group (p = 0.057). Among the measured blood gas variables there were significant differences in PvO2 (p = 0.006) and in PaCO2 (p = 0.02), and as indicators of tissue perfusion and acidosis there were significant differences in all calculated blood gas variables and in plasma lactate concentration (p = 0.0001) between the two experimental groups. Hypoxia as judged by the oxygen utilisation coefficient of over 0.5 and oxygen saturation of mixed venous blood of less than 50%, eight animals were hypoxic in the peritonitis alone group compared with one in the lymphatic blockade group (p = 0.006). CONCLUSION: Animals in which transdiaphragmatic drainage was obstructed had fewer positive blood cultures and better body oxygen balance during peritonitis, indicating that blockade of transdiaphragmatic lymphatic absorption of peritoneal contents reduced systemic inflammatory response syndrome.

Absorption↗
PubMed2005

Clinical evaluation of systemic inflammatory response syndrome (SIRS) in advanced lung cancer (T3 and T4) with surgical resection.

OBJECTIVES: The systemic inflammatory response syndrome (SIRS) is well known to occur in patients who have suffered organ damage or trauma, or undergone surgery. SIRS provides useful information in patients with morbidity after surgery. To date, there has been no report of SIRS after surgery in patients with lung cancer. Therefore, based on this new concept of the syndrome, we review here a series of T3 and T4 NSCLC patients who underwent extended resection at our hospital, and attempt to identify the value and correlation of SIRS in predicting the morbidity of such patients. METHODS: We retrospectively reviewed the patients with NSCLC treated at our hospital between January 1994 and August 2003. Among these 720 patients, a curative approach was attempted in 144 with advanced stage (T3, 100; T4, 44) cancer. The patients were consequently divided into three groups (G1, negative or less than 3 days in SIRS following surgery; G2, less than 7 days; G3, continued over 7 days). Pre- or peri-operative factors were evaluated, and the 5-year survival rates were analyzed. Post-operative morbidity was also compared between the three groups in association with SIRS. RESULTS: Pre-operative counts of WBC were 8848.28+/-3879.21/microl in G3 compared with 7383.33+/-3132.98/microl in G2 and 6778.31+/-3184.89/microl in G1. Values in G3 were significantly higher than those in the other groups (P<0.001). Predicted %FEV1 in G3 was significantly lower than those in the other groups. Duration of SIRS after lung surgery was associated with high levels in WBC and low %FEV1. Post-operative morbidity such as bronchial fistula or ARDS were more frequent in the G3 and G2 groups than in G1. The 1-year survival was as follows; G1, 75.4%; G2, 47.9%; G3, 38.1%. Overall 5-year survival rate for NSCLC with T3 and T4 was 32.2%, and the difference between G3 and the other groups in terms of survival was statistically significant (P<0.0001). CONCLUSIONS: The concept of SIRS have been associated with post-operative complications and survival in NSCLC. Surgical candidates should be carefully according to the predicting factor of SIRS.

Adenocarcinoma↗
PubMed2003

[Prospective study of systemic inflammatory response syndrome of patients with nosocomial G- bacteria infection].

OBJECTIVE: To study the characteristics of systemic inflammatory response syndrome (SIRS) of inpatients with nosocomial G- bacteria infection in order to find on effective treatment. METHODS: Eighty-two inpatients of SIRS with lower respiratory tract infection with G- bacteria were studied prospectively until discharge or death. They were divided into two groups: observation group (42 cases) and control group (40 cases). Bacteria culture of sputum and drug sensitivity was performed. Routine treatment was carried out in the control group, and rhubarb and antibiotics with lower endotoxin releasing property were given to the observation group. The course of SIRS, the incidence of MODS, and the mortality were compared. RESULTS: The duration with SIRS in observation group and control group was respectively (6.2+/-1.3) days and (7.4+/-1.2) days, u=3.91, P<0.05; the incidence of MODS was 11.4 percent and 32.3 percent, respectively, chi(2)=4.27, P<0.05. The mortality rates of the patients with SIRS in two groups were 8.6 percent and 29.0 percent, respectively. CONCLUSION: The results indicated that the treatment with rhubarb could obviously reduce the duration of SIRS compared with routine method. The same is true in the incidence of MODS and mortality rate.

Adolescent↗
PubMed2001

Increased distribution and expression of CD64 on blood polymorphonuclear cells from patients with the systemic inflammatory response syndrome (SIRS).

Evidence is growing to suggest that the multiple organ damage of the systemic inflammatory response syndrome (SIRS) arises from the untoward activity of blood polymorphonuclear cells (PMNs), which upon activation acquire the IgG high affinity receptor, CD64. In the current study, flow cytometry was used to assess the prevalence of CD64-bearing PMNs and the intensity of expression of CD64 in whole blood samples from 32 SIRS patients, 11 healthy normal subjects and from eight non-SIRS patients in the intensive care unit (ICU). The percentage of PMNs expressing CD64 was higher in SIRS patients (mean 65%) than in non-SIRS patients (mean 42%; P < 0.02) and in healthy controls (mean 19%; P < 0.001) and was particularly evident in patients with SIRS and sepsis (mean 71%; P < 0.02) as opposed to SIRS alone (mean 55%). There were more CD64 molecules expressed on PMNs from patients with SIRS (median 1331 molecules/cell) in comparison with PMNs from healthy subjects (median 678 molecules/cell; P < 0.01). The highest intensity of CD64 expression was associated with PMNs from patients with both SIRS and sepsis. Functional studies revealed that the supranormal binding of PMNs from patients with SIRS to endothelial monolayers treated with TNFalpha was impeded by anti-CD64 antibodies (mean 24% inhibition; P < 0.01). Monitoring the distribution of CD64+ PMNs and their level of CD64 expression could be of assistance in the rapid discrimination of patients with SIRS from other ICU patients and in the identification of PMNs which are likely to participate in the pathological manifestations of the disease.

Adult↗
PubMed2003

Report of a case series of ultra low-frequency oscillations in cardiac output in critically ill adults with sepsis, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome.

Healthy physiological systems exhibit irregular variability whereas diseased systems display decreased signal variability or greater regularity. The objective of this article is to report a case series of critically ill adults who displayed ultra low-frequency periodic sinusoidal oscillations in cardiac output (ULF-CO) that were discovered during a clinical study testing software for continuous physiological monitoring. Data were collected from 13 critically ill surgical and trauma patients who required continuous cardiac output monitoring. Physiologic data were collected from clinical monitors. The computerized time series of cases displaying CO oscillations were manually reviewed. Ten patients with sepsis or the systemic inflammatory response syndrome exhibited 18 episodes of ultra low-frequency periodic oscillations (ULF-CO) with frequencies ranging from 0.0028 to 0.000053 Hz (periods, 6 to 316 min). Intensive care unit mortality rate was 50%. The amplitude and coefficient of variation of cardiac output during ULF-CO ranged from 0.1-4.6 L and 3.9-14.3%, respectively. Duration of ULF-CO ranged from 4-108.1 h. ULF-CO could not be explained as a result of patterned artifact from measurement error or therapeutic intervention. ULF-CO may be a pathophysiologic marker that might serve the diagnosis, prognosis, and treatment of critical illness.

Adolescent↗
PubMedDate not supplied

Systemic inflammatory response syndrome (SIRS) as a predictor of strangulated small bowel obstruction.

BACKGROUND/AIMS: Strangulated small bowel obstruction may often carry severe morbidity or mortality when a differential diagnosis from simple small bowel obstruction was made in the past. The aim of this study is to clarify preoperative indications that can be useful for predicting strangulation in acute small bowel obstruction, and to evaluate the efficacy of systemic inflammatory response syndrome as a predictor. METHODOLOGY: Seventy clinical cases were rated between strangulated (n=40) and simple (n=30) small bowel obstruction that were postoperatively identified and were analyzed using univariate and multivariate procedure. RESULTS: Age (p=0.0377), female gender (p=0.0121), white blood cells counts (p=0.0272), presence of abdominal tenderness (p=0.0074), presence of abdominal muscle guarding (p=0.0002), American Society of Anesthesiology score (p=0.0191), number of systemic inflammatory response syndrome factors (p=0.0001), and presence of systemic inflammatory response syndrome (p=0.0001) were evaluated for correlated predictive factors in the univariate analysis. The presence of systemic inflammatory response syndrome (odds ratio= 14.3, p=0.0151) and presence of abdominal muscle guarding (odds ratio=5.87, p=0.0158) were independent predictive factors in the multivariate analysis. CONCLUSIONS: These predictive factors were considered to be useful to predict strangulated small bowel obstruction, and to contribute to the improvement of outcomes in the management of acute small bowel obstruction.

Acute Disease↗
PubMed1998

Release of mediators of systemic inflammatory response syndrome in the course of a severe delayed hemolytic transfusion reaction caused by anti-D.

BACKGROUND: In vitro studies suggest that mediators of systemic inflammatory response syndrome are generated in the course of hemolytic transfusion reactions. Evidence for the in vivo significance of these findings is given by the present clinical and laboratory analysis of a severe delayed hemolytic transfusion reaction (DHTR). CASE REPORT: A 67-year-old patient (blood group O, D-negative) with a negative pretransfusion antibody screen received a massive transfusion because of arterial bleeding (Day 1). The transfusion of group O, D-positive red cell concentrates was unavoidable because of limited supplies. At Day 10, the patient developed a DHTR with symptoms of septic-toxic syndrome and signs of hemolysis; he received an exchange transfusion. Serologic markers, as well as proinflammatory and anti-inflammatory mediators, were monitored at the onset of the DHTR and during the exchange transfusion. RESULTS: At Day 10, the direct antiglobulin test was positive; anti-D was present, most likely as the result of an anamnestic immune response. Interleukin (IL)-1 was not detectable; all other mediators monitored were elevated: IL-1 receptor antagonist, tumor necrosis factor, IL-6, IL-8, IL-10, neopterin, elastase, C3a-desArg, C-reactive protein, and fibrinogen. Most of the values declined during the exchange transfusion, which was followed by an improvement of the clinical presentation. CONCLUSIONS: Mediators of systemic inflammatory response syndrome were released in the course of a DHTR caused by anti-D. Severe clinical symptoms could be treated successfully by exchange transfusion.

APACHE↗
PubMed1997

The level of lipopolysaccharide-binding protein is significantly increased in plasma in patients with the systemic inflammatory response syndrome.

Currently, there is no way to predict with a high degree of sensitivity and specificity which patients are likely to develop systemic inflammatory response syndrome (SIRS) following systemic infection, trauma, organ rejection, or blood loss. The level of human lipopolysaccharide-binding protein (LBP) was determined in the plasma of 22 patients with a clinical diagnosis of early SIRS. Twenty-nine plasma samples from healthy volunteers were used as controls. The mean level of LBP in the plasma of healthy volunteers was 7.7 micrograms/ml (standard deviation, 6.2 micrograms/ml). Twenty-one of 22 patients (95%) with SIRS had an LBP level on admission at least 2 standard deviations above the mean LBP level for a healthy volunteer control group (range, 4.9 to 114.2 micrograms/ml; mean, 36.6 micrograms/ml; standard deviation, 22.2 micrograms/ml; P < 0.0001). The level of LBP in the plasma of the majority of patients with early SIRS is significantly increased compared to that in healthy controls. The sensitivity, specificity, and predictive value of elevated plasma LBP levels in patients with SIRS remain to be determined.

Acute-Phase Proteins↗
PubMed1999

[A clinical study on systemic inflammatory response syndrome and multiple organ dysfunction syndrome in patients with abdominal surgical emergency].

In order to analyze the development from systemic inflammatory response syndrome(SIRS) to multiple organ dysfunction syndrome (MODS) and probe the therapeutic strategies, the authors studied retrospectively the clinical data of SIRS and MODS in 1374 patients with abdominal surgical emergency. The results showed that on admission the morbidity of SIRS was 32.5%, afterwards the morbidity of MODS was 6.4%, and the mortality of the patients with SIRS was 4.8%. After 48 hours' therapy, MODS developed in 33.0% of the SIRS cases. Of all the 1374 patients, 40 developed MODS(2.9%) and 27 died (67.5%). The authors point out that the outcome of the patients with abdominal surgical emergency can be improved on condition that SIRS is early diagnosed, the cause of SIRS after 48 hours of therapy is well defined, and the body inflammatory response is properly regulated.

Abdomen, Acute↗
PubMed1995

Role of systemic inflammatory response syndrome and infection in the occurrence of early multiple organ dysfunction syndrome following severe trauma.

OBJECTIVE: To evaluate the role of infection and systemic inflammatory response syndrome (SIRS) on the occurrence of early posttraumatic MODS. DESIGN: Retrospective study. SETTING: University Teaching Hospital ICU. PATIENTS: 163 consecutive patients hospitalized for more than 48 hours following severe trauma. MEASUREMENTS AND MAIN RESULTS: The patients were classified into two groups in respect to the existence of MODS at day 2. There was 27 patients in the MODS group and 136 patients in the no MODS group. The two groups were similar with respect to age, sex ratio and Simplified Acute Physiology Score. The MODS group had a higher mortality (52 versus 7%), Injury Severity Score (45 +/- 14 versus 31 +/- 13), hypovolemic shock rate (74 versus 30%), massive volume replacement rate (59 versus 6%) and SIRS rate (81 versus 54%) than the no MODS group (P < 0.05). The rate of infection was similarly low in the MODS and no MODS group (4 versus 6% respectively). CONCLUSION: Early MODS is often associated with hypotension and massive volume administration but very rarely with infection, despite the high rate of SIRS.

Adult↗
PubMed2003

Possible role of increased oxidant stress in multiple organ failure after systemic inflammatory response syndrome.

OBJECTIVE: Host response to infection and other forms of tissue injury have been termed systemic inflammatory response syndrome (SIRS). This inflammatory response can frequently be accompanied by oxidative injury in one or more organ systems in the body. The objective of this report was to clarify the possible role of oxidative stress in the development of multiple organ failure (MOF) in patients with SIRS. DESIGN: Prospective clinical study. SETTING: Intensive care unit in a university hospital. PATIENTS: A total of 214 consecutive patients (mean age, 57.1 +/- 17.4 yrs; range, 13 to 84 yrs; 148 men and 66 women). At the time of admission, 139 patients fulfilled the clinical criteria for SIRS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We measured plasma concentrations of thiobarbituric acid reactant substances (TBARS), as an index of oxidative stress, every day from the point of admission to the intensive care unit until discharge or death. Furthermore, all variables of the SIRS score and the Sequential Organ Failure Assessment score were collected every day. At the time of admission, plasma TBARS concentrations in SIRS patients with MOF were significantly higher than those in SIRS patients without MOF (2.3 +/- 0.9 vs. 1.9 +/- 0.6 nmol/mL, p <.01), and there was a significant correlation between plasma TBARS concentration and Sequential Organ Failure Assessment score (r2 =.18, p <.001). Furthermore, the duration of SIRS persistence was significantly associated with the percentage increase in plasma TBARS concentration during SIRS persistence in those patients in whom the duration of SIRS was confirmed (r2 =.73, p <.001). The duration of SIRS was significantly higher in patients who developed MOF than in patients who did not develop MOF (6.9 vs. 3.2 days, p <.001). The percentage increase in plasma TBARS concentration during SIRS was also significantly higher in patients who developed MOF than in patients who did not develop MOF (57.1% vs. 15.8%, p <.001). CONCLUSIONS: It can be concluded that processes of oxidative stress in connection with continued SIRS may promote the development of MOF.

Adolescent↗