Predisposition, insult/infection, response and organ dysfunction (PIRO): a pilot clinical staging system for hospital mortality in patients with infection

To develop a clinical staging system based on the PIRO concept (Predisposition, Infection, RESPONSE and Organ dysfunction) for hospitalized patients with infection. One year prospective cohort study of all hospitalized patients with infection (n = 1035), admitted into a large tertiary care, universi...

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Bibliographic Details
Published in:PloS one 2013-07, Vol.8 (7), p.e70806-e70806
Main Authors: Cardoso, Teresa, Teixeira-Pinto, Armando, Rodrigues, Pedro Pereira, Aragão, Irene, Costa-Pereira, Altamiro, Sarmento, António E
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Analysis
Antibiotics
Arteriosclerosis
Atherosclerosis
Blood diseases
Cancer
Cancer therapies
Classification
Clinical trials
Diabetes
Disease Susceptibility - mortality
Failure
Female
Health aspects
Hematological diseases
Hospital Mortality
Hospital patients
Hospitals
Humans
Hyperglycemia
Hypotension
Infection
Infection - mortality
Infections
Information systems
Intensive care
Liver diseases
Male
Medical research
Medicine
Middle Aged
Mortality
Nosocomial infections
Patient outcomes
Patients
Physiology
Pneumonia
Prospective Studies
Regression coefficients
Risk factors
Sepsis
Sex Factors
Tachypnea
Ventilators
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Summary:To develop a clinical staging system based on the PIRO concept (Predisposition, Infection, RESPONSE and Organ dysfunction) for hospitalized patients with infection. One year prospective cohort study of all hospitalized patients with infection (n = 1035), admitted into a large tertiary care, university hospital. Variables associated with hospital mortality were selected using logistic regressions. Based on the regression coefficients, a score for each PIRO component was developed and a classification tree was used to stratify patients into four stages of increased risk of hospital mortality. The final clinical staging system was then validated using an independent cohort (n = 186). Factors significantly associated with hospital mortality were • for Predisposition: age, sex, previous antibiotic therapy, chronic hepatic disease, chronic hematologic disease, cancer, atherosclerosis and a Karnofsky index50%. Finally, this new clinical staging system was studied in a validation cohort, which provided similar results (0%, 9%, 31% and 67%, in each stage, respectively). Based on the PIRO concept, a new clinical staging system was developed for hospitalized patients with infection, allowing stratification into four stages of increased mortality, using the different scores obtained in Predisposition, RESPONSE, Infection and Organ dysfunction. The proposed system will likely help to define inclusion criteria in clinical trials as well as tailoring individual management plans for patients with infection.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0070806