Utility of the systemic inflammatory response syndrome (SIRS) criteria in predicting the onset of septic shock in hospitalized patients with hematologic malignancies.

Background: The systemic inflammatory response syndrome (SIRS) criteria have not been validated in patients with hematologic malignancies (HM).

Objective: To determine whether daily assessment of SIRS criteria allows early identification of HM patients who will develop septic shock (SS).

Design: Observational, single-center,nested case-control study.

Setting: Oncology unit of a tertiary care center.

Patients: 547 consecutive, hospitalized, HM subject were enrolled. Using incidence-density sampling, 184 controls were matched to 46 SS cases.

Measurements: The study exposure was the SIRS score. The study outcome was the development of SS during the hospitalization.

Main Results: 8.4% of subjects developed SS. SIRS scores measured 24 hours prior to SS were significantly higher in cases than in controls (2.1 vs. 1.4,p<0.0001). Using standard SIRS cutpoints, fever, tachypnea and tachycardia were each associated with the onset of SS. Population-specific SIRS criteria were empirically derived.

Limitations: Single-center study. Further validation is warranted.

Conclusions: SIRS can identify HM patients at risk for SS at least 24 hours before SS onset. These data may lead to evidence-based guidelines using routine vital signs to risk-stratify HM patients for SS.