Int J Biol Med Res.

2021 ;12(2):7280-7284
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Original article
SIRS in ICU, A Clinical Study
Dr. Santosh Kumbhar, Dr. E.J. David, Dr. P. M. Kulkarni, Dr. Santosh Kumbhar
Wanless Hospital, Miraj, Maharashtra

ARTICLE INFO ABSTRACT

Keywords: INTRODUCTION: Localized inflammation is physiological protective response which is

SIRS
generally tightly controlled by the body at the site of injury. Loss of this local control or an overly
ICU
MANAGEMENT
activated response results in an exaggerated systemic response which is clinically identified as
systemic inflammatory response syndrome (SIRS). Compensatory mechanism are initiated in
concert with SIRS and outcome (resolution multiple organ dysfunction syndrome or death) is
dependent on the balance of SIRS and such compensatory mechanisms. SIRS may occur in
association with common non-infectious conditions such as high risk surgery and trauma. In
fact mortality rates are similar between infectious and non-infectious conditions associated
with SIRS. The incidence and associated mortality and morbidity rates of SIRS are commonly
underestimated. This is a function of number of factors. Thus this study was done by evaluating
clinical features and prognostic factors affecting course of SIRS, which would be useful in
predicting the prognosis and deciding the treatment policies. METHODS: The present study has
been carried out in the Department of General Medicine, Wanless Hospital, Miraj, in Sangli
district of Maharashtra over a period from January 2019 to September 2020. A total 60 patients
with SIRS were studied fulfilling the inclusion and exclusion criteria. It was a prospective
observational clinical study. Consecutive type of non probability sampling was followed for the
selection of study subjects. RESULTS: The prevalence of systemic inflammatory response
syndrome was 24.48%.The majority of patients were in age group 41-50 years (30%). The
mean age of patients was 42.11 ± 8.67 years. Out of 60 patients, majority of patients were
females (53.33%) while males were 46.67%.The majority of patients were having symptom of
fever (100%) followed by headache (70%), vomiting (53.33%), myalgia (46.67%), bleeding
tendency (35%), abdominal pain (31.67%) and others (18.33%)The majority of patients were
having Diabetes Mellitus & hypertension (18.33%). Among 60 patients, CVD, Stroke, thyroid
disorders and kidney disorders was observed in 15%, 11.67%, 8.33% and 6.67% respectively.
Among 60 patients, Multi organ failure, encephalopathy and ARDS was observed in 5%, 3.33%
and 5% respectively. The mean hemoglobin was 12.73 ± 2.231 g/dl. The mean total bilirubin
was 1.11 ± 0.40 mg/dl. The mean ALT was 24.86 ± 6.17. The mean AST was 23.53 ± 5.70. The
mean blood urea was 31.96 ± 12.21 mg/dl. The mean serum creatinine was 2.76 ± 1.01.The
mean APACHE II score was 21.9 ± 6.82. The mean MODS score was 6.63 ± 3.05.The mortality
among patients with SIRS was 6.67%. CONCLUSION: SIRS is commonly present in patients
presenting to the emergency department. Once SIRS is identified, it is crucially important to
keep the patient under observation so that rapid and appropriate treatment can be initiated to
decrease the mortality among patients.

c
Copyright 2010 BioMedSciDirect Publications IJBMR - ISSN: 0976:6685. All rights reserved.

Introduction
The concept of a systemic inflammatory response syndrome The concept of a systemic inflammatory response syndrome
(SIRS) to describe the complex pathophysiologic response to an (SIRS) to describe the complex pathophysiologic response to an
insult such as infection, trauma, burns, pancreatitis, or a variety of insult such as infection, trauma, burns, pancreatitis, or a variety of
other injuries came from a 1991 consensus conference charged
with the task of developing an easy-to- apply set of clinical
* Corresponding Author : Dr. E.J. David parameters to aid in the early identification of potential candidates
128, IHR Hostel, Wanless Hospital, Miraj Medical Centre, Miraj,
District Sangli, Maharashtra – 416410; Phone: 7972773674
to enter into clinical trials to evaluate new treatments for sepsis.1
c Copyright 2011. CurrentSciDirect Publications. IJBMR - All rights reserved.
 Dr. Santosh Kumbhar et al./Int J Biol Med Res.12(2):7280-7284
7281

In 1992, the American College of Chest Physicians (ACCP) and MATERIALS AND METHODS:
the Society of Critical Care Medicine (SCCM) introduced definitions
Study Design:
for systemic inflammatory response syndrome (SIRS), sepsis, severe
sepsis, septic shock, and multiple organ dysfunction syndrome The present study was a hospital based prospective study
(MODS).1 The idea behind defining SIRS was to define a clinical undertaken to study clinical profile of patients presenting with
response to a nonspecific insult of either infectious or noninfectious Systemic Inflammatory Response Syndrome.
origin. SIRS is defined as 2 or more of the following variables:
Study Period:
• Fever of more than 38°C (100.4°F) or less than 36°C (96.8°F)
The study period was January 2019 to September 2020
• Heart rate of more than 90 beats per minute
Study Population:
• Respiratory rate of more than 20 breaths per minute or arterial
The study population was patients admitted in Wanless Hospital
carbon dioxide tension (PaCO2) of less than 32 mm Hg
and fulfilling the selection criteria during the study period.
• Abnormal white blood cell count (>12,000/µL or <4,000/µL or
Sample Size:
>10% immature [band] forms)
A total of 60 cases attending OPD and admitted in hospital during
Since this time, more than 100 clinical trials have used these
study period considering the inclusion and exclusion criteria were
criteria for the inclusion of patients,2 including recently published
included in the study.
trials.3-5 However, the utility of the SIRS criteria for the selection of a
more critically ill group of patients who are expected to benefit from Sampling technique and Study subjects:
early identification and timely intervention remains controversial.
The sample size for the present study was calculated by using the
In 1995, Rangel-Frausto et al. showed that up to 64% of ward
below mentioned formula.
patients have SIRS during their hospital stay.6 More recently,
Churpek et al. demonstrated an incidence of SIRS of nearly 50% in
ward patients.7 These findings support the low specificity of the SIRS
criteria for the selection of patients at a higher risk of death because
most hospitalized patients develop SIRS at some point during their n- Sample size
stay. Finally, Kaukonen et al. concluded that the SIRS criteria missed
one in eight patients with severe sepsis, challenging the notion of the Z= percentage point corresponding to significance level.
high sensitivity of the available criteria for the definition of sepsis at For significance level 5%, Z is 1.96.
that time.8 ● P is the prevalence of systemic inflammatory response
Some authors have advocated the systematic documentation of syndrome (taken as 80.71%)1
SIRS status upon hospital admission to guide clinical decisions
● E is corresponding maximum error and is 10%
regarding the presence of infection and prognosis.9 However, SIRS
may occur in association with common non-infectious conditions, Thus the approximate sample size for the present study was;
such as highrisk surgery10 and trauma.11 In fact, mortality rates are n=59.1. So, by rounding off, we have taken 60 subjects suffering
similar between infectious and non- infectious conditions associated from Systemic Inflammatory Response Syndrome.
with SIRS.12 Therefore, the SIRS criteria alone may not effectively
discriminate between infected and non-infected patients.
Sampling Technique: Consecutive type of non-probability
Thus, the present study was conducted for evaluating clinical
sampling was followed for the selection of study subjects. A total of
profile of systemic inflammatory response syndrome at tertiary
60 patients fulfilling the eligibility criteria of Systemic Inflammatory
intensive care unit.
Response Syndrome were taken for study after taking informed
consent.
AIM AND OBJECTIVES: Selection of Cases: Cases were selected from Wanless Hospital
Intensive Care Units. After selection of cases detailed history, clinical
Aim:
examination and then investigations were carried out.
● To study the clinical profile of patients presenting with Systemic
Inflammatory Response Syndrome. Criteria For selection of Cases:
Patient meeting any two of the following criteria were diagnosed
Objectives:
as case of Systemic Inflammatory Response Syndrome1:
1. To study the prevalence of systemic
inflammatory response syndromeat tertiary intensive care unit. 1. Body temperature ≥38°C or <36°C,

2. To study the clinical features of patients with systemic 2. Heart rate >90/min,
inflammatory response syndrome 3. Respiration >20/min or PaCO2 <32 mmHg, and
3. To study the factors associated with the systemic inflammatory 4. White blood cell (WBC) count >12.0 x 109/L or <4.0 x 109/L, or
response syndrome >10% immature (band) forms.
All the patients were treated with appropriate and standard
treatment protocol.
 Dr. Santosh Kumbhar et al./Int J Biol Med Res.12(2):7280-7284
7282

RESULTS: Table c) : Distribution of patients according to comorbidities:*

The present cross-sectional study was conducted to study
clinical profile of systemic inflammatory response syndrome at
tertiary intensive care unit.
The study revealed the following points as follows:
The prevalence of systemic inflammatory response syndrome
was 24.48%.
The majority of patients were in age group 41-50 years (30%)
followed by 31-40 years (21.67%) The mean age of patients was
42.11 ± 8.67 years.
Out of 60 patients, majority of patients were females (53.33%)
while males were 46.67%.The majority of patients were having
symptom of fever (100%) followed by headache (70%), vomiting
(53.33%), myalgia (46.67%), bleeding tendency (35%), abdominal
pain (31.67%) and others (18.33%)The majority of patients were Table d) : Distribution of patients according to Complications:*
having Diabetes Mellitus & hypertension (18.33%). Among 60
patients, CVD, Stroke, thyroid disorders and kidney disorders was
observed in 15%, 11.67%, 8.33% and 6.67% respectively. The
majority of patients were having hepatic dysfunction (10%)
followed by renal failure (8.33%).Among 60 patients, Multi organ
failure, encephalopathy and ARDS was observed in 5%, 3.33% and
5% respectively.The mean hemoglobin was 12.73 ± 2.231 g/dl.The
mean PT was12.3 ± 3.38.The mean INR was 0.87 ± 0.34 and mean
APTT was 34.58 ± 5.14.The mean total bilirubin was 1.11 ± 0.40
mg/dl. The mean ALT was 24.86 ± 6.17. The mean AST was 23.53 ±
5.70.The mean albumin was 3.88 ± 0.70.The mean blood urea was
31.96 ± 12.21 mg/dl. The mean serum creatinine was 2.76 ±
1.01.The mean APACHE II score was 21.9 ± 6.82. The mean MODS
score was 6.63 ± 3.05.The mortality among patients with SIRS was
6.67%.

TABLES : Table a) : Prevalence of SIRS among patients:

Table e) : Distribution of Patients according to outcome:

Table b) : Prevalence of SIRS according to age:

CHARTS: I)
 Dr. Santosh Kumbhar et al./Int J Biol Med Res.12(2):7280-7284
7283

II)
Taniguchi LU et al14 studied systemic inflammatory response
syndrome criteria can predict hospital mortality in a Brazilian
cohort observed mean age among patients of 65.6 (17.7) years. Out
of 60 patients, majority of patients were females (53.33%) while
males were 46.67%.
Andrew H Bissonette et al16 in a study on Systemic
Inflammatory Response Syndrome (SIRS) in the emergency
department observed of the subjects, 463 (46.7%) were male. The
findings were similar to present study.
Taniguchi LU et al14 studied systemic inflammatory response
syndrome criteria can predict hospital mortality in a Brazilian
cohort observed male population of 54.9%.

DISCUSSION: The majority of patients were having symptom of fever (100%)

followed by headache (70%), vomiting (53.33%), myalgia
The present observational cross-sectional study was conducted (46.67%), bleeding tendency(35%), abdominal pain (31.67%) and
to study clinical profile of systemic inflammatory response others (18.33%).
syndrome at tertiary intensive care unit.
The majority of patients were having hypertention & Diabetes
Patients presenting with systemic inflammatory response Mellitus (18.33%). Among 60 patients, CVD, Stroke, thyroid
syndrome admitted in Wanless Hospital and fulfilling the selection disorders and kidney disorders was observed in 15%, 11.67%,
criteria were included in the study. A sample size of 60 patients with 8.33% and 6.67% respectively.
SIRS was enrolled in the study. Patients not willing to participate
were excluded from study. The patient was informed about the Pål Comstedt et al9 studied relationship between SIRS
study and informed and written consent was obtained from the symptoms and morbidity and mortality in medical emergency ward
patient. A detailed history of the patient with clinical examination patients observed co- morbidity among 43% patients.
was done. Data was entered in a specially designed proforma made The majority of patients were having hepatic dysfunction
for recording the findings. (10%) followed by renal failure (8.33%). Among 60 patients, Multi
In the present study, out of 245 patients admitted to hospital 60 organ failure, encephalopathy and ARDS was observed in 5%,
patients have SIRS showing prevalence of 24.48%. 3.33% and 5% respectively.

Andrew H Bissonette et al16 in a study on Systemic Inflammatory Sharmila Chatterjee et al13 in a observational study in the
Response Syndrome (SIRS) in the emergency department observed intensive therapy units (ITU) observed out of total of 3,010 ITU
admissions, SIRS with organ dysfunction was found in 365 (11.97
the overall prevalence of SIRS (defined as the presence of ≥ 2 SIRS %) patients. The mean hemoglobin was 12.7 ± 2.231 g/dl. The mean
criteria) was 24.9%. The findings were similar to present study. PT was 12.3 ±3.38.
Sharmila Chatterjee et al13 in a observational study in the The mean INR was 0.89 ± 0.34 and mean APTT was 34.58 ± 5.14.
intensive therapy units (ITU) observed that out of total of 3,010 ITU The mean total bilirubin was 1.1 ± 0.4 mg/dl. The mean ALT was
admissions, SIRS was found in 365 (11.97 %) patients.Paulo R. A. 24.86 ± 6.17. The mean AST was 23.53 ± 5.7. The mean albumin was
Carvalho et al15 conducted a study to assess the prevalence of 3.88 ± 0.7. The mean blood urea was 31.96 ± 12.21 mg/dl. The mean
systemic inflammatory syndromes observed prevalence of serum creatinine was 2.76 ± 1.01.
systemic inflammatory response syndrome (SIRS) was 68%.
The mean APACHE II score was 21.9 ± 6.82. The mean MODS
In Japan, the prevalence of SIRS reached 84% among all adult score was 6.63 ± 3.05.
ICU patients17. SIRS affected one third of all hospitalized patients in
the study by Brun-Buisson18; it developed in 59% of critically ill Daniel A. Bonville et al22 studied mortality in critically ill
obstetric patients19 and 82% of admissions to a university hospital patients with systemic inflammatory response syndrome observed
in Canada20. Among hospitalized adult medical patients with new APACHE II score of 19.8 ± 0 60.
onset of fever in the department of internal medicine, 95% had In the present study, it was observed that, the majority of
SIRS21. These data are not fully comparable with our data because patients survived (93.33%) while 4 (6.67%) patients died.
different patient populations were studied.
Sharmila Chatterjee et al13 in a observational study in the
In the present study, the majority of patients were in age group intensive therapy units (ITU) observed that mortality among
41-50 years (30%) followed by 31-40 years (21.67%) The mean age patients was 8%.
of patients was 42.11 ± 13.43 years.
Daniel A. Bonville et al22 studied mortality in critically ill
Andrew H Bissonette et al16 in a study on Systemic patients with systemic inflammatory response syndrome observed
Inflammatory Response Syndrome (SIRS) in the emergency mortality of 24.77%.
department observed participants' mean age was 47.0 ± 20.1 years
with a range from 18 to 97 years. The findings were similar to Taniguchi LU et al14 studied systemic inflammatory response
present study. syndrome criteria can predict hospital mortality in a Brazilian
cohort observed mortality of 16.9%.
Daniel A. Bonville et al22 studied mortality in critically ill
patients with systemic inflammatory response syndrome observed The results have some limitations. First, this was a single-center
mean age of 64.5 ±6 1.6 Years. retrospective cohort from a private hospital, which could have
biased some of our results and limited generalisability.
 Dr. Santosh Kumbhar et al./Int J Biol Med Res.12(2):7280-7284
7284

CONCLUSION: [12] Dulhunty JM, Lipman J, Finfer S; Sepsis Study Investigators for the ANZICS
Clinical Trials Group. Does severe non-infectious SIRS differ from severe
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(24.28%) among hospitalized patients. SIRS is commonly present care unit study. Intensive Care Med. 2008;34(9):1654-61.
in patients presenting to the emergency department. Its presence [13] Chatterjee S, Chattopadhyay A, Todi SK. Outcomes of Severe Sepsis among
indicates a higher frequency of co-morbidities and further Adults in a Tertiary Care Hospital in Kolkata – A Preliminary Study. J Anest &
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Hence, once SIRS is identified, it is crucially important to keep [14] Taniguchi LU, Pires EM, Vieira Jr. JM, Azevedo LC. Systemic inflammatory
the patient under observation so that rapid and appropriate response syndrome criteria and the prediction of hospital mortality in
critically ill patients: a retrospective cohort study. Rev Bras Ter Intensiva.
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2017;29(3):317-324
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[15] Carvalho PR, Feldens L, Seitz EE, Rocha TS, Soledade MA, Trotta EA.
ACKNOWLEDGEMENTS: Prevalence of systemic inflammatory syndromes at a tertiary pediatric
intensive care unit. J Pediatr (Rio J). 2005;81:143-8.
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Medicine Department, Wanless Hospital, Miraj, Dr. P.M. Kulkarni, [16] Bissonette AH, Tuttle AP, Grzybowski M, Nowak RM, Ander DS, Morris DC et
M.D. Med, Chief consultant, Department of Medicine, and Dr. al) Systemic Inflammatory Response Syndrome (SIRS) in the emergency
Nathaniel Sase MD (Med), DM (Neuro), Director, Wanless Hospital, department: An original investigation – A look back in timeEmerg Med Crit
Care, 2018Volume 1(3): 4-7
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