Secondary analysis of multicenter randomized controlled trials.
PATIENTS: None.
MEASUREMENTS AND MAIN RESULTS: The prevalence of
systemic inflammatory response syndrome was described in the 1,186 patients (64.4%) with data available for all
systemic inflammatory response syndrome criteria. Using multiple imputations for the 1,843 patients (96.8%) with available endpoints, we compared the 90-day prevalence of death,
shock,
heart failure, or
stroke between patients with and without
systemic inflammatory response syndrome at presentation and at 24 hours post admission.
Systemic inflammatory response syndrome was defined as ≥2 of 1) heart rate>90 beats/min, 2) respiratory rate>20 breaths/min, 3) body temperature>38 or <36°C, or 4) leukocyte count>12 or<4×10/L. At presentation, 25.0% of patients met
systemic inflammatory response syndrome criteria; at 24 hours, 8.1% of patients met
systemic inflammatory response syndrome criteria. The primary outcome was more frequent among patients with
systemic inflammatory response syndrome at presentation (31.0% vs 16.7%; adjusted hazard ratio, 1.78 [95% CI, 1.35-2.34]; p<0.001) and at 24 hours (36.7% vs 11.1%; adjusted hazard ratio, 2.84 [95% CI, 2.03-3.97]; p<0.001). Mortality at 90 days was also higher among patients with
systemic inflammatory response syndrome at either time point. Each additional
systemic inflammatory response syndrome criterion was independently associated with 90-day outcomes at the time of presentation (adjusted hazard ratio, 1.41 per
systemic inflammatory response syndrome criteria [95% CI, 1.24-1.61]; p<0.001) and at 24 hours (adjusted hazard ratio, 1.72 per
systemic inflammatory response syndrome criteria [95% CI, 1.47-2.01]; p<0.001).
CONCLUSION: