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POWH Journal Club Article Review

The Clinical Value of Systemic Inflammatory Response Syndrome (SIRS) in Abdominal Aortic Aneurysm Repair. Norwood M, Bown M, Lloyd G, Bell P, Sayers R.Dept of Surg, University of Leicester, Leicester, UKEur J Vasc Endovasc Surg 2004; 27(3): 292-298. Purpose. To determine whether number of SIRS cr

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POWH Journal Club Article Review

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    1. POWH Journal Club Article Review Ben Kwok SRMO

    2. The Clinical Value of Systemic Inflammatory Response Syndrome (SIRS) in Abdominal Aortic Aneurysm Repair Norwood M, Bown M, Lloyd G, Bell P, Sayers R. Dept of Surg, University of Leicester, Leicester, UK Eur J Vasc Endovasc Surg 2004; 27(3): 292-298

    3. Purpose To determine whether number of SIRS criteria and timing of SIRS correlates with multiple organ failure (MOF) and outcome in patients after AAA surgery

    4. Background SIRS = 2 or more of these criteria (Bone et al Chest 1992) WCC>12 or <4 or >10% immature (band) forms Temp >38C or <36C Heart Rate > 90/min Resp Rate >20/min or PaCO2 < 4.3kPa (32.25 mmHg) SIRS ? sepsis ? septic shock ? multiple organ dysfunction

    5. Methods 151 consecutive AAA repair patients prospectively recruited (Oct 00-Apr 02) Inclusion criteria- Any AAA repair: Elective (100) Urgent (16) symptomatic + repair <24h post admission Ruptured (35) intra or retroperitoneal blood at laparotomy No exclusion criteria Daily record post-op of SIRS score number of SIRS criteria 0-4

    6. Methods Outcome measures included Organ failure as defined by Knaus et al (Ann Surg 1985) multiple if >2 organs failed Mortality Length of stay in hospital Length of stay in surgical ward Length of stay in critical care unit

    7. Organ Failure

    8. Results Elective AAA 89% - SIRS at some point during admission 54% - SIRS only during first 3 post-op days Pts that died (n=5) had prolonged and higher mean SIRS scores 2.19 c/w 0.95 (p<0.01) High early SIRS score ? no correlation with adverse outcome Cumulative SIRS score >10 in 1st 4 post-op days correlated with higher mortality (p=0.02 Fishers exact test)

    9. Results Elective AAA SIRS scores of 3 or 4 during 1st 4 post-op days had higher incidence of MOF. 1/51 with SIRS score=2 developed MOF 6/49 with SIRS score=3 developed MOF BUT No statistically significant difference (Fishers exact test p=0.06) If SIRS during 5th-10th day post-op more likely to die (p=0.01 Fishers exact test) longer ward stay (16.37 days vs 10.94 days) p=0.02 Students t-test)

    10. Results Ruptured AAA All 35 patients had SIRS post-op Non-survivors had higher mean SIRS score than survivors 2.06 vs 1.37 (p<0.01 t-test) BUT no difference in survival whether peak SIRS score was 2, 3 or 4 (no test or p-value quoted) Pts that stayed in hospital longer than the mean time had higher mean SIRS score 1.76 vs 1.26 (p=0.04) Again, No statistically significant correlation between tighter SIRS criteria (3 or 4) and MOF (p=0.85 ?2)

    11. Conclusions of Authors No correlation between precise number of SIRS criteria and mortality, length of hospital stay or organ failure In elective AAA repairs High cumulative SIRS scores (=10) in 1st 4 days post-op?more likely to die High SIRS score on isolated days not associated with increased mortality Presence of SIRS from day 5-10?longer hospital stay and higher mortality (not influenced by peak SIRS score) In ruptured AAA repairs Early high SIRS scores regardless of outcome

    12. Problems No statistically significant correlation between MOF and tighter SIRS definition (3 or 4 criteria) ? Any correlation between SIRS and MOF at all in this study not looked at in this study ? SIRS ? sepsis ? septic shock ? multiple organ dysfunction hypothesis still valid More complex analysis of data required to find significant results

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