The systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores are effective triage markers following paracetamol overdose - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Alimentary Pharmacology and Therapeutics Année : 2011

The systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores are effective triage markers following paracetamol overdose

Résumé

BACKGROUND: The Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) scores are widely used as prognostic markers in critical care settings and could improve triage of high-risk paracetamol (acetaminophen) overdose patients. AIM: To evaluate the prognostic accuracy of the SIRS and SOFA scores following single time point paracetamol overdose. METHODS Analysis of 100 single time-point paracetamol overdoses admitted to a tertiary liver centre, with subsequent prospective validation of identified thresholds. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post-overdose, and the daily SOFA and SIRS scores calculated. RESULTS A total of 74 (74%) patients developed the SIRS, which occurred significantly earlier in patients who died (n=21) compared with spontaneous survivors (n=53, p=0.05). The SIRS occurred in 70 (70%) patients by 96 hours post-overdose, with a 30% mortality rate; compared with 0% mortality in the 30 non-SIRS patients (p=0.001). Median SOFA scores were significantly higher in non-survivors at 48 (p=0.009), 72 (p<0.001), and 96 hours (p<0.001). A SOFA score >7 during the first 96 hours post-overdose predicted death/transplantation with a sensitivity of 95.0 (95% CI 78.5-99.1) and specificity of 70.5 (95% CI 66.3-71.6). A validation cohort of 38 single time-point paracetamol overdoses confirmed the extremely high negative predictive value of both the SIRS and SOFA thresholds. CONCLUSIONS The absence of either a SOFA score >7 or a SIRS response during the first 96 hours following paracetamol overdose could improve triage and reduce transfers of lower risk patients to tertiary liver centres.

Mots clés

Fichier principal
Vignette du fichier
PEER_stage2_10.1111%2Fj.1365-2036.2011.04687.x.pdf (838.52 Ko) Télécharger le fichier
Origine : Fichiers produits par l'(les) auteur(s)
Loading...

Dates et versions

hal-00639782 , version 1 (10-11-2011)

Identifiants

Citer

Darren George Norman Craig, Thomas Wdj Reid, Kirsty G Martin, Janice S Davidson, Peter C Hayes, et al.. The systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores are effective triage markers following paracetamol overdose. Alimentary Pharmacology and Therapeutics, 2011, 34 (2), pp.219. ⟨10.1111/j.1365-2036.2011.04687.x⟩. ⟨hal-00639782⟩

Collections

PEER
59 Consultations
810 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More