Utilidad y aplicación de los criterios para Síndrome de Respuesta Inflamatoria Sistémica (SRIS) en pacientes con infecciones severas admitidos por urgencias.

Abstract

RESUMEN: Objetivo: evaluación de la utilidad de los criteriospara SIRS comparados con el diagnóstico final deinfección en pacientes admitidos en urgencias de dos hospitales universitarios. Diseño: estudio decohorte longitudinal. Sitio: Hospital Universitario San Vicente de Paúl y Hospital General de Medellín,Medellín, Colombia. Pacientes: 734 pacientes con sospecha de infección como diagnóstico principal para la admisión en urgencias. Mediciones: la sensibilidad, la especificidad, los valores predictivos y las razones de probabilidad (RP) de los criterios de SIRS en la admisión, fueron determinados usando como estándares de oro el diagnóstico en el momento del alta basado en la historia clínica y la evolución, y la confirmación microbiológica de la infección.

ABSTRACT: Objective: evaluation of the usefulness of criteria for SIRS compared with the final diagnosis of infection, in patients admitted to the emergency room of two university-based hospitals. Design: longitudinal cohort study. Setting: Hospital Universitario San Vicente de Paul, third level university hospital, and Hospital General de Medellín, third level non university hospital (Medellín, Colombia). Participants: 734 patients with suspected bacterial infection as main diagnosis for admittance into the emergency room. Main outcome measures: sensitivity, specificity, predictive values and likelihood ratios (LR) of SIRS criteria at admission were determined using as gold standards the diagnosis at discharge time, based on clinical history and evolution, and microbiological confirmation of infection. Results: SIRS criteria were met by 503 patients (68.5%); discharge diagnosis of infection was found in 657 (89.4%) and 276 (37%) had microbiological confirmation. SIRS criteria exhibited a sensitivity of 69%, specificity of 37%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 13% and positive LR of 1.09. There were not differences between both gold standards. Conclusions: the finding of two or more SIRS criteria was of little usefulness for diagnosis of infection. It is necessary to evaluate new criteria in order to obtain a simple, precise and an operative definition of the sepsis phenomenon. Key Words: Sepsis, Systemic Inflammatory Response Syndrome, Diagnosis, Sensibility.