COMPARATIVE ANALYSIS OF BASELINE CHARACTERISTICS AND CLINICAL OUTCOMES IN SIRS AND SEPSIS PATIENTS: A PROSPECTIVE STUDY
Main Article Content
Keywords
Sepsis, Systemic Inflammatory Response Syndrome (SIRS), SOFA score, Glasgow Coma Scale, mortality, low- and middle-income countries (LMICs), ICU
Abstract
Background:
Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated immune response to infection. It is a major cause of morbidity and mortality globally, particularly in low- and middle-income countries (LMICs). The Sequential Organ Failure Assessment (SOFA) score and Glasgow Coma Scale (GCS) are critical markers for predicting sepsis outcomes.
Objective:
This study aims to compare the baseline characteristics and clinical outcomes of patients diagnosed with Systemic Inflammatory Response Syndrome (SIRS) and sepsis in a resource-limited setting, focusing on the role of clinical diagnostic parameters like SOFA, GCS, and other vital signs.
Methods:
A prospective cohort observational study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi, from June 2023 to June 2024. A total of 200 patients, including 79 with SIRS and 121 with sepsis, were included. Baseline characteristics, clinical parameters (SOFA, GCS, blood pressure, respiratory rate), and outcomes (mortality, ICU stay) were assessed. Data were analyzed using SPSS, and statistical significance was set at p < 0.05.
Results:
Sepsis patients were older, with a significantly higher mortality rate (58.3% vs. 13.9% in SIRS, p < 0.01). SOFA and GCS scores were significantly worse in sepsis patients compared to those with SIRS, both on Day 1 and Day 3 (p < 0.01). Culture positivity was significantly higher in sepsis patients (29.8% vs. 6.3% in SIRS, p = 0.01). The study also revealed significant hemodynamic and neurological deterioration in sepsis patients.
Conclusion:
Sepsis patients exhibit significantly higher organ dysfunction and mortality compared to SIRS patients. The SOFA and GCS scores proved valuable in predicting clinical outcomes. The findings highlight the urgent need for improved sepsis management, early diagnosis, and better healthcare resources in LMICs to reduce the high mortality associated with sepsis.
Keywords: Sepsis, Systemic Inflammatory Response Syndrome (SIRS), SOFA score, Glasgow Coma Scale, mortality, low- and middle-income countries (LMICs), low- and middle-income countries (LMICs)
References
2. Anireddy, D. (2024). ENHANCING CLINICAL DECISION-MAKING IN LOW-RESOURCE SETTINGS: COMPARING MORTALITY RISK SCORES FOR ADULT CRITICAL CARE PATIENTS IN LESOTHO DURING THE COVID-19 PANDEMIC Johns Hopkins University].
3. Arora, J., Mendelson, A. A., & Fox-Robichaud, A. (2023). Sepsis: network pathophysiology and implications for early diagnosis. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 324(5), R613-R624.
4. Barroso, J. M. L. A. (2023). Sepsis endotypes and phenotypes: biomarkers and clinical phenotypes upon ICU admission: a systematic review.
5. Belden, B. (2023). The Impact of Sepsis Screening Integration in the Outpatient Setting. Oklahoma City University.
6. Cao, M., Wang, G., & Xie, J. (2023). Immune dysregulation in sepsis: experiences, lessons and perspectives. Cell Death Discovery, 9(1), 465.
7. Cassini, A., Allegranzi, B., Fleischmann-Struzek, C., Kortz, T., Markwart, R., Saito, H., Bonet, M., Brizuela, V., Mehrtash, H., & Tuncalp Mingard, Ö. (2020). Global Report on the epidemiology and burden on sepsis: current evidence, identifying gaps and future directions. Global Report on the epidemiology and burden on sepsis: current evidence, identifying gaps and future directions.
8. Cavaillon, J. M., Singer, M., & Skirecki, T. (2020). Sepsis therapies: learning from 30 years of failure of translational research to propose new leads. EMBO molecular medicine, 12(4), e10128.
9. Censi, S., Manso, J., & Mian, C. (2023). Other markers of medullary thyroid cancer, not only calcitonin. European Journal of Endocrinology, 188(1), R1-R13.
10. Chahin, A., & Opal, S. M. (2020). The Clinical Approach to Sepsis and Its Mimics in the Critical Care Unit. In Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine (pp. 147-154). CRC Press.
11. Chou, E. H., Mann, S., Hsu, T.-C., Hsu, W.-T., Liu, C. C.-Y., Bhakta, T., Hassani, D. M., & Lee, C.-C. (2020). Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: a nationwide study. PloS one, 15(1), e0227752.
12. Cinel, I., Kasapoglu, U. S., Gul, F., & Dellinger, R. P. (2020). The initial resuscitation of septic shock. Journal of Critical Care, 57, 108-117.
13. de Guadiana-Romualdo, L. G., Botella, L. A., Rojas, C. R., Candel, A. P., Sánchez, R. J., Zamora, P. C., Albaladejo-Otón, M. D., & Allegue-Gallego, J. M. (2024). Mortality prediction model from combined serial lactate, procalcitonin and calprotectin levels in critically ill patients with sepsis: A retrospective study according to Sepsis-3 definition. Medicina Intensiva (English Edition).
14. Deusenbery, C., Wang, Y., & Shukla, A. (2021). Recent innovations in bacterial infection detection and treatment. ACS Infectious Diseases, 7(4), 695-720.
15. He, R.-R., Yue, G.-L., Dong, M.-L., Wang, J.-Q., & Cheng, C. (2024). Sepsis Biomarkers: Advancements and Clinical Applications—A Narrative Review. International Journal of Molecular Sciences, 25(16), 9010.
16. Heming, N., Azabou, E., Cazaumayou, X., Moine, P., & Annane, D. (2021). Sepsis in the critically ill patient: current and emerging management strategies. Expert Review of Anti-Infective Therapy, 19(5), 635-647.
17. Joosten, S. C., Wiersinga, W. J., & van der Poll, T. (2024). Dysregulation of Host–Pathogen Interactions in Sepsis: Host-Related Factors. Seminars in Respiratory and Critical Care Medicine,
18. Kashyap, R., Sherani, K. M., Dutt, T., Gnanapandithan, K., Sagar, M., Vallabhajosyula, S., Vakil, A. P., & Surani, S. (2021). Current utility of sequential organ failure assessment score: a literature review and future directions. The Open Respiratory Medicine Journal, 15, 1.
19. La Via, L., Sangiorgio, G., Stefani, S., Marino, A., Nunnari, G., Cocuzza, S., La Mantia, I., Cacopardo, B., Stracquadanio, S., & Spampinato, S. (2024). The Global Burden of Sepsis and Septic Shock. Epidemiologia, 5(3), 456-478.
20. Lahiri, R., Rehan, M., Banerjee, S., Gadre, S., Paul, P., & Gupta, S. (2022). The Utility of SOFA Score and Acute Physiology and Chronic Health Evaluation (APACHE II) Score in Analysing Patients with Multiple Organ Dysfunction Syndrome and Sepsis. International Journal of Medical and All Body Health Research, 3(04), 18-47.
21. Lee, S., Song, J., Park, D. W., Seok, H., Ahn, S., Kim, J., Park, J., Cho, H.-j., & Moon, S. (2022). Diagnostic and prognostic value of presepsin and procalcitonin in non-infectious organ failure, sepsis, and septic shock: a prospective observational study according to the Sepsis-3 definitions. BMC infectious diseases, 22(1), 8.
22. Liengswangwong, W., Siriwannabhorn, R., Leela-Amornsin, S., Yuksen, C., Sanguanwit, P., Duangsri, C., Kusonkhum, N., & Saelim, P. (2024). Comparison of Modified Early Warning Score (MEWS), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) for early prediction of septic shock in diabetic patients in Emergency Departments. BMC Emergency Medicine, 24(1), 161.
23. Machado, F. R., Cavalcanti, A. B., Braga, M. A., Tallo, F. S., Bossa, A., Souza, J. L., Ferreira, J. F., Pizzol, F. d., Monteiro, M. B., & Angus, D. C. (2023). Sepsis in Brazilian emergency departments: a prospective multicenter observational study. Internal and Emergency Medicine, 18(2), 409-421.
24. Madkour, A. M., ELMaraghy, A. A., & Elsayed, M. M. (2022). Prevalence and outcome of sepsis in respiratory intensive care unit. The Egyptian Journal of Bronchology, 16(1), 29.
25. Martínez, M. L., Plata-Menchaca, E. P., Ruiz-Rodríguez, J. C., & Ferrer, R. (2020). An approach to antibiotic treatment in patients with sepsis. Journal of thoracic disease, 12(3), 1007.
26. Mun, S.-J., Cho, E., Kim, H. K., Gil, W. J., & Yang, C.-S. (2024). Enhancing acute inflammatory and sepsis treatment: superiority of membrane receptor blockade. Frontiers in Immunology, 15, 1424768.
27. Muzammil, M. M., Mohiuddin, M. F., Arif, A., & Qurram, S. M. N. (2024). MICROBIOLOGICAL PROFILE OF NEONATAL SEPSIS IN NICU OF TERTIARY CARE HOSPITAL. Int J Acad Med Pharm, 6(2), 824-828.
28. Nedeva, C. (2021). Inflammation and cell death of the innate and adaptive immune system during sepsis. Biomolecules, 11(7), 1011.
29. Nguyen, H. B., Rivers, E. P., Abrahamian, F. M., Moran, G. J., Abraham, E., Trzeciak, S., Huang, D. T., Osborn, T., Stevens, D., & Talan, D. A. (2006). Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Annals of emergency medicine, 48(1), 54. e51.
30. Qin, Y. (2024). Deriving Biological Meaning and Clinical Application for Pediatric Sepsis with Data-driven Analysis University of Pittsburgh].
31. Stenberg, H., Li, X., Pello-Esso, W., Lönn, S. L., Thønnings, S., Khoshnood, A., Knudsen, J. D., Sundquist, K., & Jansåker, F. (2023). The effects of sociodemographic factors and comorbidities on sepsis: A nationwide Swedish cohort study. Preventive medicine reports, 35, 102326.
32. Taylor, S. P., Chou, S.-H., Sierra, M. F., Shuman, T. P., McWilliams, A. D., Taylor, B. T., Russo, M., Evans, S. L., Rossman, W., & Murphy, S. (2020). Association between adherence to recommended care and outcomes for adult survivors of sepsis. Annals of the American Thoracic Society, 17(1), 89-97.
33. Teoh, T. K. (2022). The role and impact of molecular diagnostics in modern clinical microbiology University of Limerick].
34. Thomson, K. (2022). Assessment of antibiotic resistance in pathogens causing neonatal sepsis, associated mortality and recommended treatment options in low-and middle-income countries Cardiff University].
35. Wang, M., Jiang, L., Zhu, B., Li, W., Du, B., Kang, Y., Weng, L., Qin, T., Ma, X., & Zhu, D. (2020). The prevalence, risk factors, and outcomes of sepsis in critically ill patients in China: a multicenter prospective cohort study. Frontiers in Medicine, 7, 593808.
36. Wayland, J., Teixeira, J. P., & Nielsen, N. D. (2024). Sepsis in 2024: A Review. Anaesthesia & Intensive Care Medicine.
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Dr. Erum Amir
MBBS, MPhil, CHPE, Assistant Professor, Department of Pathology, Karachi Metropolitan University, Pakistan
Dr. Shazia Fahmi
MBBS, MPhil, CHPE, Assistant Professor, Department of Anatomy, Karachi Metropolitan University, Pakistan
Dr. Javeria Maqsood
MBBS, FCPS, Cardiologist, Senior Registrar, National Medical Centre, Karachi Pakistan
Dr. Amtul Quddos Latif
MBBS, MCPS, MPhil, CHPE, Associate Professor and HOD, Main Clinical and Diagnostic Laboratory, JPMC, Karachi Pakistan
Dr. Rabia Arshad
Professor, Department of Pharmacology, Dow International Dental College, Dow University of Health Sciences, Karachi Pakistan
Nuzhat Firdous
Principal College of Nursing , CMH, Institute of Medical Sciences(CIMS), Bahawalpur