Systemic inflammatory response syndrome score may indicate increased risk of major amputation in patients with diabetic foot infection

Background: This study was done to diagnose the severity of infection in a group of hospitalized diabetic foot infection (DFI) patients based on the presence or absence of systemic inflammatory response syndrome (SIRS) and compare the outcomes.Methods: This was a single-center cohort study, in which 50 consecutive DFI patients having SIRS and 50 consecutive patients not having SIRS were included. Patients were followed for the duration of the hospital stay; parameters for glycaemic control, minor and major amputation, microbial culture, duration of hospital and ICU stay and mortality was recorded.Results: The relative risk of major amputation among the patients of DFI who presented with SIRS was 2.66 times higher compared to who was not having SIRS at presentation (95% CI, 1.56-4.55). The presence of polymicrobial infection also had a statistically significant association with the incidence of major amputation. The duration of hospital stay was ~9.5 days longer in the DFI patients who presented with SIRS compared to who was not having SIRS at the time of presentation [8.00 (4.00-20.50) days versus 17.50 (10.75-38.25) days]. DFI patients with SIRS required a significantly prolonged ICU.Conclusions: SIRS can be used as objective criteria to predict poorer outcomes in the diabetic foot infection patient and also to classify it.

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Diabetic Foot Infection Presenting Systemic Inflammatory Response Syndrome: A Unique Disorder of Systemic Reaction from Infection of the Most Distal Body

Journal of Clinical Medicine ◽

10.3390/jcm8101538 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1538 ◽

Cited By ~ 1

Author(s):

Cheng-Wei Lin ◽

Shih-Yuan Hung ◽

Chung-Huei Huang ◽

Jiun-Ting Yeh ◽

Yu-Yao Huang

Keyword(s):

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Hospital Mortality ◽

Diabetic Foot ◽

Poor Prognosis ◽

Systemic Inflammatory Response ◽

The Body ◽

Clinical Factors ◽

Diabetic Foot Infection ◽

Grade 3

Diabetic foot infection (DFI) is a major complication of diabetic foot that lead to nontraumatic lower-extremity amputation (LEA). Such distal infection of the body having systemic inflammatory response syndrome (SIRS) is rarely reported. Consecutive patients treated for limb-threatening DFI in a major diabetic foot center in Taiwan were analyzed between the years 2014 to 2017. Clinical factors, laboratory data, perfusion, extent, depth, infection and sensation (PEDIS) wound score in 519 subjects with grade 3 DFI and 203 presenting SIRS (28.1%) were compared. Major LEA and in-hospital mortality were defined as poor prognosis. Patients presenting SIRS had poor prognosis compared with those with grade 3 DFI (14.3% versus 6.6% for major LEA and 6.4% versus 3.5% for in-hospital mortality). Age, wound size, and HbA1c were independent risk factors favoring SIRS presentation. Perfusion grade 3 (odds ratio 3.37, p = 0.044) and history of major adverse cardiac events (OR 2.41, p = 0.036) were the independent factors for poor prognosis in treating patients with DFI presenting SIRS. SIRS when presented in patients with DFI is not only limb- but life-threatening as well. Clinicians should be aware of the clinical factors that are prone to develop and those affecting the prognosis in treating patients with limb-threatening foot infections.

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Systemic inflammatory response syndrome and multiple-organ damage / dysfunction in complicated canine babesiosis

Journal of the South African Veterinary Association ◽

10.4102/jsava.v72i3.640 ◽

2001 ◽

Vol 72 (3) ◽

Cited By ~ 58

Author(s):

C. Welzl ◽

A.L. Leisewitz ◽

L.S. Jacobson ◽

T. Vaughan-Scott ◽

E. Myburgh

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Renal Involvement ◽

Organ Damage ◽

Multiple Organ ◽

Systemic Inflammatory Response ◽

The Body ◽

Increased Risk

This study was designed to document the systemic inflammatory response syndrome (SIRS) and multiple-organ dysfunction syndrome (MODS) in dogs with complicated babesiosis, and to assess their impact on outcome. Ninety-one cases were evaluated retro-spectively for SIRS and 56 for MODS. The liver, kidneys, lungs, central nervous system and musculature were assessed. Eighty-seven percent of cases were SIRS-positive. Fifty-two percent of the cases assessed for organ damage had single-organ damage and 48 % had MODS. Outcome was not significantly affected by either SIRS or MODS, but involvement of specific organs had a profound effect. Central nervous system involvement resulted in a 57 times greater chance of death and renal involvement in a 5-fold increased risk compared to all other complications. Lung involvement could not be statistically evaluated owing to co-linearity with other organs, but was associated with high mortality. Liver and muscle damage were common, but did not significantly affect outcome. There are manysimilarities between the observations in this study and previous human and animal studies in related fields, lending additional support to the body of evidence for shared underlying pathophysiological mechanisms in systemic inflammatory states.

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Systemic Inflammatory Response Syndrome Is Associated With Increased Mortality Across the Spectrum of Shock Severity in Cardiac Intensive Care Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.120.006956 ◽

2020 ◽

Vol 13 (12) ◽

Author(s):

Jacob C Jentzer ◽

Patrick R. Lawler ◽

Sean van Diepen ◽

Timothy D. Henry ◽

Venu Menon ◽

...

Keyword(s):

Intensive Care ◽

Systemic Inflammatory Response Syndrome ◽

Inflammatory Response ◽

Organ Failure ◽

Proportional Hazards ◽

Illness Severity ◽

Cox Proportional Hazards ◽

Systemic Inflammatory Response ◽

Increased Risk ◽

Cardiac Intensive Care

Background: The systemic inflammatory response syndrome (SIRS) frequently occurs in patients with cardiogenic shock and may aggravate shock severity and organ failure. We sought to determine the association of SIRS with illness severity and survival across the spectrum of shock severity in cardiac intensive care unit (CICU) patients. Methods: We retrospectively analyzed 8995 unique patients admitted to the Mayo Clinic CICU between 2007 and 2015. Patients with ≥2/4 SIRS criteria based on admission laboratory and vital sign data were considered to have SIRS. Patients were stratified by the 2019 Society for Cardiovascular Angiography and Interventions (SCAI) shock stages using admission data. The association between SIRS and mortality was evaluated across SCAI shock stage using logistic regression and Cox proportional-hazards models for hospital and 1-year mortality, respectively. Results: The study population had a mean age of 67.5±15.2 years, including 37.2% women. SIRS was present in 33.9% of patients upon CICU admission and was more prevalent in advanced SCAI shock stages. Patients with SIRS had higher illness severity, worse shock, and more organ failure, with an increased risk of mortality during hospitalization (16.8% versus 3.8%; adjusted odds ratio, 2.1 [95% CI, 1.7–2.5]; P <0.001) and at 1 year (adjusted hazard ratio, 1.4 [95% CI, 1.3–1.6]; P <0.001). After multivariable adjustment, SIRS was associated with higher hospital and 1-year mortality among patients in SCAI shock stages A through D (all P <0.01) but not SCAI shock stage E. Conclusions: One-third of CICU patients meet clinical criteria for SIRS at the time of admission, and these patients have higher illness severity and worse outcomes across the spectrum of SCAI shock stages. The presence of SIRS identified CICU patients at increased risk of short-term and long-term mortality. Further study is needed to determine whether systemic inflammation truly drives SIRS in this population and whether patients with SIRS respond differently to supportive therapies for shock.

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