From the Guidelines
The SIRS criteria are no longer widely supported as the primary guideline for identifying sepsis, and have been largely replaced by newer tools such as the Sepsis-3 criteria and the qSOFA score. The original SIRS criteria, which included temperature >38°C or <36°C, heart rate >90 beats/minute, respiratory rate >20 breaths/minute or PaCO2 <32 mmHg, and white blood cell count >12,000/mm³ or <4,000/mm³ or >10% immature bands, as described in the 2016 study 1, were found to be overly sensitive but not specific enough. This led to overdiagnosis and potentially unnecessary treatments.
Newer Guidelines
The newer Sepsis-3 definition focuses on life-threatening organ dysfunction caused by a dysregulated host response to infection, with organ dysfunction measured by an increase in the SOFA score of 2 points or more. For rapid bedside assessment, qSOFA uses three criteria: altered mental status, systolic blood pressure ≤100 mmHg, and respiratory rate ≥22 breaths/minute. These newer tools better predict outcomes and help identify patients at higher risk of mortality, allowing for more targeted interventions and resource allocation in sepsis management.
Comparison with Other Studies
A study published in 2019 in the World Journal of Emergency Surgery 1 discussed the management of severe acute pancreatitis, but also touched on the concept of SIRS and its limitations. The study highlighted the importance of organ failure in defining the severity of acute pancreatitis, and how persistent organ failure is strongly associated with the risk of death or local complications. This further supports the shift away from SIRS criteria as the primary guideline for identifying sepsis.
Key Points
- The SIRS criteria are no longer widely supported as the primary guideline for identifying sepsis.
- Newer tools such as the Sepsis-3 criteria and the qSOFA score are preferred for identifying sepsis.
- The Sepsis-3 definition focuses on life-threatening organ dysfunction caused by a dysregulated host response to infection.
- qSOFA uses three criteria: altered mental status, systolic blood pressure ≤100 mmHg, and respiratory rate ≥22 breaths/minute.
- These newer tools better predict outcomes and help identify patients at higher risk of mortality.
From the Research
Systemic Inflammatory Response Syndrome (SIRS) Criteria Guideline Support
The support for the SIRS criteria guideline is a topic of ongoing debate in the medical community.
- The SIRS criteria have been used for diagnosis since 1992, but recent studies have proposed the use of the quick Sequential Organ Failure Assessment (qSOFA) score as a replacement or alternative [ 2, 3 ].
- Some studies have found that the qSOFA score has better predictive validity for in-hospital mortality than the SIRS criteria, particularly in non-ICU encounters [ 3 ].
- However, other studies have found that the SIRS criteria are more sensitive and have better diagnostic timeliness than the qSOFA score in identifying sepsis in the emergency department [ 4, 5 ].
- A prospective cross-sectional multicentre study found that the qSOFA score performed as well as the SIRS criteria for identifying culture-positive sepsis and performed significantly better for predicting in-hospital mortality and ICU admission [ 6 ].
Comparison of SIRS Criteria and qSOFA Score
The comparison of the SIRS criteria and the qSOFA score is crucial in determining the best approach for identifying sepsis in the emergency department.
- The SIRS criteria have been widely used, but they have been criticized for being too sensitive and non-specific [ 2 ].
- The qSOFA score, on the other hand, has been proposed as a more specific and sensitive tool for identifying sepsis, particularly in non-ICU encounters [ 3 ].
- However, the qSOFA score has also been criticized for being too complex and difficult to use in clinical practice [ 4 ].
- Ultimately, the choice between the SIRS criteria and the qSOFA score depends on the specific clinical context and the needs of the patient [ 5, 6 ].