The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.

<h4>Introduction</h4>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.<h4>Objectives</h4>To ide...

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Autores principales:	Cristina Granja, Pedro Póvoa, Cristina Lobo, Armando Teixeira-Pinto, António Carneiro, Altamiro Costa-Pereira
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/073afbe366614aab9ec32ad14d49adbf
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spelling	oai:doaj.org-article:073afbe366614aab9ec32ad14d49adbf2021-11-18T08:00:54ZThe predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.1932-620310.1371/journal.pone.0053885https://doaj.org/article/073afbe366614aab9ec32ad14d49adbf2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23349756/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>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.<h4>Objectives</h4>To identify variables to be included in each component of PIRO aiming to improve the hospital mortality prediction.<h4>Methods</h4>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.<h4>Results</h4>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 (IC(95%):0.81-0.87) and a test of goodness-of-fit (Hosmer and Lemeshow) of p = 0.368.<h4>Conclusions</h4>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.Cristina GranjaPedro PóvoaCristina LoboArmando Teixeira-PintoAntónio CarneiroAltamiro Costa-PereiraPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 1, p e53885 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Cristina Granja Pedro Póvoa Cristina Lobo Armando Teixeira-Pinto António Carneiro Altamiro Costa-Pereira The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.
description	<h4>Introduction</h4>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.<h4>Objectives</h4>To identify variables to be included in each component of PIRO aiming to improve the hospital mortality prediction.<h4>Methods</h4>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.<h4>Results</h4>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 (IC(95%):0.81-0.87) and a test of goodness-of-fit (Hosmer and Lemeshow) of p = 0.368.<h4>Conclusions</h4>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.
format	article
author	Cristina Granja Pedro Póvoa Cristina Lobo Armando Teixeira-Pinto António Carneiro Altamiro Costa-Pereira
author_facet	Cristina Granja Pedro Póvoa Cristina Lobo Armando Teixeira-Pinto António Carneiro Altamiro Costa-Pereira
author_sort	Cristina Granja
title	The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.
title_short	The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.
title_full	The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.
title_fullStr	The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.
title_full_unstemmed	The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.
title_sort	predisposition, infection, response and organ failure (piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/073afbe366614aab9ec32ad14d49adbf
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The predisposition, infection, response and organ failure (Piro) sepsis classification system: results of hospital mortality using a novel concept and methodological approach.

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