Systemic inflammatory response syndrome criteria and the prediction of hospital mortality in critically ill patients: a retrospective cohort study

ABSTRACT Objective: This study intended to determine whether the systemic inflammatory response syndrome criteria can predict hospital mortality in a Brazilian cohort of critically ill patients. Methods: We performed a retrospective cohort study at a private tertiary hospital in São Paulo (SP), Brazil. We extracted information from the adult intensive care unit database (Sistema EpimedTM). We compared the SAPS 3 and the systemic inflammatory response syndrome model as dichotomous (≥ 2 criteria: systemic inflammatory response syndrome -positive versus 0 - 1 criterion: systemic inflammatory response syndrome -negative) and ordinal variables from 0 to 4 (according to the number of systemic inflammatory response syndrome criteria met) in the prediction of hospital mortality at intensive care unit admission. Model discrimination was compared using the area under the receiver operating characteristics (AUROC) curve. Results: From January to December 2012, we studied 932 patients (60.4% were systemic inflammatory response syndrome -positive). systemic inflammatory response syndrome -positive patients were more critically ill than systemic inflammatory response syndrome -negative patients and had higher hospital mortality (16.9% versus 8.1%, p摘要： 目的：本研究旨在明确全身炎症反应综合征（systemic inflammatory response syndrome, SIRS）诊断标准能否在巴西重症患者队列中预测住院病死率。 方法：本研究于巴西圣保罗市某私立三级医院开展回顾性队列研究，从成人重症监护病房（intensive care unit, ICU）数据库（Sistema EpimedTM）中提取研究数据。本研究将简化急性生理学评分3（SAPS 3）与SIRS模型分别设置为二分类变量（满足≥2项SIRS诊断标准为SIRS阳性，满足0~1项为SIRS阴性），以及按满足SIRS诊断标准的数量划分为0~4分的有序分类变量，以评估重症监护病房收治时的住院病死率预测效能。采用受试者工作特征曲线下面积（AUROC）比较不同模型的区分度。 结果：2012年1月至12月，本研究共纳入932例患者，其中60.4%为SIRS阳性。SIRS阳性患者的病情较SIRS阴性患者更为危重，住院病死率更高（16.9% vs. 8.1%，p