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

Abstract : 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.
keyword : Medicine
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Submitted on : Thursday, November 10, 2011 - 2:59:10 AM
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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, Wiley, 2011, 34 (2), pp.219. ⟨10.1111/j.1365-2036.2011.04687.x⟩. ⟨hal-00639782⟩

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