• Juan G Posadas-Calleja, Henry T Stelfox, Andre Ferland, Danny J Zuege, Daniel J Niven, Luc Berthiaume, and Christopher James Doig.
• All authors are at the University of Calgary, Calgary, Alberta, Canada. Juan G. Posadas-Calleja is a clinical assistant professor, Department of Critical Care Medicine. Henry T. Stelfox is a professor, Departments of Critical Care Medicine, Community Health Sciences, and Medicine. Andre Ferland is a clinical associate professor, Departments of Critical Care Medicine and Medicine. Danny J. Zuege is a clinical professor, Department of Critical Care Medicine and Division of Respiratory Medicine. Daniel J. Niven is an assistant professor, Departments of Critical Care Medicine and Community Health Sciences. Luc Berthiaume is a clinical associate professor, Departments of Critical Care Medicine and Community Health Sciences and Division of Respiratory Medicine. Christopher James Doig is a professor and head, Department of Critical Care Medicine, and a professor, Departments of Community Health Sciences and Medicine.
• Am. J. Crit. Care. 2018 Jul 1; 27 (4): 287-294.

BackgroundMortality in patients with intra-abdominal sepsis remains high. Recognition and classification of patients with sepsis are challenging; about 70% of critical care specialists find the existing definitions confusing and not clinically useful.ObjectiveTo assess the usefulness of the predisposition, infection/injury, response, organ dysfunction (PIRO) concept in surgical intensive care patients with severe sepsis or septic shock due to an intra-abdominal source.MethodsData from 2005 through 2010 of a prospective observational cohort were reviewed retrospectively.ResultsAmong 905 patients, overall mortality was 21.3%, but patients with septic shock had a mortality of 40.6%. The variables in each PIRO subset with P ≤ .10 were entered into a stepwise backward elimination logistic regression. A PIRO score was developed that included the following variables: age greater than 65 years; comorbid conditions; leukopenia; hypothermia; and cardiovascular, renal, respiratory, and central nervous system failure. One point was given for each feature detected. The mean score was significantly higher (P < .001) in non-survivors (3.9) than in survivors (2.3). When the data were distributed according to PIRO scores, mortality rate increased (P < .001). The area under the receiver operating characteristic curve indicated consistent mortality discrimination by PIRO scores (0.80; 95% CI, 0.79-0.83), outperforming the Acute Physiology and Chronic Health Evaluation II (0.72; 95% CI, 0.68-0.75) and the Sequential Organ Failure Assessment (0.72; 95% CI, 0.68-0.76) (P < .001).ConclusionThe PIRO score is useful for predicting mortality in patients with surgically related intra-abdominal sepsis.©2018 American Association of Critical-Care Nurses.

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