Posadas-Calleja et al developed a PIRO model for patients with intra-abdominal sepsis. This can help to identify a patient who may require more aggressive management. The authors are from the University of Calgary.
Patient selection: surgical patient with sepsis associated with an intra-abdominal source
Outcome: ICU mortality
Model: PIRO (predisposition, infection, response, organ dysfunction)
Predisposition: age and comoribidity
Infection: not scored
Response: leukopenia, hypothermia
Organ dysfunction: cardiovascular, respiratory, renal, central nervous system
Parameters:
(1) age in years
(2) comorbid conditions (end-stage renal disease, lung disease, liver disease, immunosuppression)
(3) leukopenia (white blood cell count < 4,000 per µL)
(4) hypothermia (body temperature < 36.0°C)
(5) cardiovascular dysfunction
(6) respiratory dysfunction
(7) renal dysfunction
(8) central nervous system dysfunction
|
Parameter
|
Finding
|
Points
|
|
age in years
|
<= 65 years
|
0
|
|
|
> 65 years
|
1
|
|
comorbid conditions
|
absent
|
0
|
|
|
present
|
1
|
|
leukopenia
|
absent
|
0
|
|
|
present
|
1
|
|
hypothermia
|
absent
|
0
|
|
|
present
|
1
|
|
cardiovascular dysfunction
|
absent
|
0
|
|
|
present
|
1
|
|
respiratory dysfunction
|
absent
|
0
|
|
|
present
|
1
|
|
renal dysfunction
|
absent
|
0
|
|
|
present
|
1
|
|
CNS dysfunction
|
absent
|
0
|
|
|
present
|
1
|
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the greater the morbidity.
|
Score
|
Mortality Rate
|
|
0
|
1%
|
|
1
|
3%
|
|
2
|
10%
|
|
3
|
21%
|
|
4
|
37%
|
|
5
|
54%
|
|
6
|
68%
|
|
7 or 8
|
99+%
|
Performance:
• The area under the ROC curve is 0.80.
