The Predisposition, Infection, Response and Organ Failure (Piro) Sepsis Classification System: Results of Hospital Mortality Using a Novel Concept and Methodological Approach

• Type: Article in International Scientific Journal
• Date: 2013

Authors

Granja C (Author) FMUP; Póvoa P (Author) Other; Lobo C (Author) Other; Teixeira-Pinto A (Author) FMUP; Carneiro A (Author) Other; Altamiro da Costa Pereira (Author) FMUP

Journal

Title: PLoS ONE

Vol. 8 No. 1

Pages: e53885-e53885

ISSN: 1932-6203

Publisher: Public Library of Science

Indexing

ISI Web of Knowledge - 27 Citations

ISI Web of Science

Scopus - 37 Citations

Pubmed / Medline

Scientific classification

FOS: Medical and Health sciences

Other information

Authenticus ID: P-002-16S

DOI: 10.1371/journal.pone.0053885

Abstract (EN): Introduction: PIRO is a conceptual classification system in which a number of demographic, clinical, biological and laboratory variables are used to stratify patients with sepsis in categories with different outcomes, including mortality rates. Objectives: To identify variables to be included in each component of PIRO aiming to improve the hospital mortality prediction. Methods: Patients were selected from the Portuguese ICU-admitted community-acquired sepsis study (SACiUCI). Variables concerning the R and O component included repeated measurements along the first five days in ICU stay. The trends of these variables were summarized as the initial value at day 1 (D1) and the slope of the tendency during the five days, using a linear mixed model. Logistic regression models were built to assess the best set of covariates that predicted hospital mortality. Results: A total of 891 patients (age 60 +/- 17 years, 64% men, 38% hospital mortality) were studied. Factors significantly associated with mortality for P component were gender, age, chronic liver failure, chronic renal failure and metastatic cancer; for I component were positive blood cultures, guideline concordant antibiotic therapy and health-care associated sepsis; for R component were C-reactive protein slope, D1 heart rate, heart rate slope, D1 neutrophils and neutrophils slope; for O component were D1 serum lactate, serum lactate slope, D1 SOFA and SOFA slope. The relative weight of each component of PIRO was calculated. The combination of these four results into a single-value predictor of hospital mortality presented an AUC-ROC 0.84 (IC95%: 0.81-0.87) and a test of goodness-of-fit (Hosmer and Lemeshow) of p = 0.368. Conclusions: We identified specific variables associated with each of the four components of PIRO, including biomarkers and a dynamic view of the patient daily clinical course. This novel approach to PIRO concept and overall score can be a better predictor of mortality for patients with community-acquired sepsis admitted to ICUs.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9