Serial measurements of SIRS criteria to identify unique phenotypes of sepsis: A Microbiologic Approach

Harman S Gill*, Phuong H Nguyen, Jada M English, Kayla A Fay, Elisha Fleig Yin MPAS, Jaskirat Kaur Gill, Todd D Morrell

Introduction: The utility of serial scoring systems in identifying distinct sepsis phenotypes remains unknown.

Methods: Eligible adults were classified into culture-positive (Cx+) and culture-negative (Cx-) groups alongside pre-defined culture subgroups. Average SIRS & SEP (novel scoring system) scores were calculated at t = 0 and hours 3,6,12 & 24 before and after t = 0. The primary outcome was a difference in SIRS/SEP scores amongst those that were Cx+ or Cx- at any time point. Secondary outcomes were comparing total and component SIRS/SEP scores in microbiologic subgroups over serial time points. 

Results: 4,701 Cx+ and 3254 Cx- patients met eligibility criteria. Statistically significant differences were seen in the average SIRS score between Cx + and Cx- groups at hours six (Cx+ 1.40+1.04 vs Cx- 1.35+1.01) & 12 (Cx+ 0.95+0.95 vs Cx- 0.90+0.90) after t = 0. The hematologic, urologic, and neurologic subgroups had significant differences at numerous time points before and after T = 0. Similar findings were observed with the SEP scores. Cx+ and Cx- groups (including subgroups) consistently doubled both SIRS/SEP scores before t = 0 with an eventual return to baseline values after T = 0 but at different gradients. 

Conclusion: Significant differences in SIRS/SEP scores were seen in Cx+ & Cx- patients at sequential time points. This microbiologic approach in homogenous culture cohorts has the potential to identify distinct phenotypes of sepsis efficiently and practically. Consistent increases in SIRS/SEP scores before t = 0 and sequential decreases after t = 0 may allow for early detection, intervention, and provision for real-time monitoring of therapeutic responses in patients with concerns for sepsis.

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Published on: Aug 29, 2023 Pages: 16-24

Full Text PDF Full Text HTML DOI: 10.17352/2455-5363.000057
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