Infectious Disease Book


Systemic Inflammatory Response Syndrome

Aka: Systemic Inflammatory Response Syndrome, SIRS
  1. See Also
    1. Sepsis in Adults
    2. Sepsis in Children
    3. qSOFA Score
    4. Sequential Organ Failure Assessment Score (SOFA Score)
  2. Indications
    1. Sepsis Evaluation (replaced by SOFA Score and qSOFA Score as of 2016)
  3. Background
    1. SIRS suggests an inflammatory response
    2. SIRS is a screening tool for Sepsis
      1. High Test Sensitivity for Sepsis
      2. Poor Test Specificity for Sepsis (any inflammation can cause SIRS)
    3. Sepsis is present when infection accompanies at least 2 positive SIRS criteria
      1. Significance of this definition of Sepsis is that it is correlated with a higher mortality risk than infection without SIRS
  4. Efficacy
    1. Sepsis Test Sensitivity: 50-60%
      1. Fails to identify one in eight patients admitted to ICU with severe Sepsis
      2. Tusgul (2017) Scand J Trauma Resusc Emerg Mefd 25(1):108 [PubMed]
      3. Kaukonen (2015) N Engl J Med 372(17): 1629-38 [PubMed]
  5. Criteria: Adults (Positive if 2 of the 4 signs are present)
    1. Body Temperature < 36 C (96.8 F) or > 38 C (100.4 F)
    2. Heart Rate >90 bpm
    3. Tachypnea (>20 breaths per minute) or PaCO2 <32 mmHg
    4. White Blood Cell Count <4000 cells/mm3 or >12,000 cells/mm3 or >10% immature Neutrophils (Band Neutrophils)
  6. Criteria: Children (Positive if 2 of the 4 signs are present)
    1. Major (at least one of these must be present)
      1. Core Temperature >38.5 C (101.3 F) or <36 C (96.8 F)
      2. Leukocyte count elevated or depressed for age or >10% immature Neutrophils (Band Neutrophils)
        1. Abnormal Leukocyte count not due to Chemotherapy
    2. Minor
      1. Tachypnea
        1. Mean Respiratory Rate >2 SD above normal for age or
        2. Mechanical Ventilation for acute reason not related to underlying neuromuscular disorder or general Anesthesia
      2. Abnormal Heart Rate
        1. Tachycardia
          1. Mean Heart Rate 2 SD above normal for age or unexplained persistent elevation for at least 0.5 hours
          2. Not due to external or painful stimuli, longterm medication use
        2. Bradycardia in children <1 year of age
          1. Mean Heart Rate <10th percentile for age or unexplained persistent depression for at least 0.5 hours
          2. Not due to external Vagal Stimulation, Beta Blockers or Congenital Heart Disease
  7. Signs: Children - SIRS Criteria Vital Signs
    1. Age <1 week
      1. Heart Rate >180 or <100 per minute
      2. Respiratory Rate >50 per minute
      3. White Blood Cell Count >34k
    2. Age 1 to 4 weeks
      1. Heart Rate >180 or <100 per minute
      2. Respiratory Rate >40 per minute
      3. White Blood Cell Count >19.5k or <5.5k
    3. Age 1 to 24 months
      1. Heart Rate >180 or <90 per minute
      2. Respiratory Rate >34 per minute
      3. White Blood Cell Count >17.5k or <5.5k
    4. Age 2 to 6 years
      1. Heart Rate >140 per minute
      2. Respiratory Rate >22 per minute
      3. White Blood Cell Count >15.5k or <6k
    5. Age 6 to 13 years
      1. Heart Rate >130 per minute
      2. Respiratory Rate >18 per minute
      3. White Blood Cell Count >13.5k or 4.5k
    6. Age 13 to 18 years
      1. Heart Rate >110 per minute
      2. Respiratory Rate >14 per minute
      3. White Blood Cell Count >11k or <4.5k
  8. Differential Diagnosis
    1. Infection (Sepsis)
      1. Bacterial Infection (most common)
      2. Also fungal, parasitic or Viral Infection
    2. Trauma
    3. Burn Injury
    4. Post-surgery
    5. Pancreatitis
    6. Pulmonary Embolism
    7. Anaphylaxis
    8. Drug Overdose
    9. Vasculitis
    10. Autoimmune syndrome
  9. References
    1. Khoujah (2013) Crit Dec Emerg Med 27(4):12-21
    2. Annane (2005) Lancet 365(9453): 63-78 [PubMed]
    3. Bone (1992) Chest 101:1644-55 [PubMed]
    4. Goldstein (2005) Pediatr Crit Care Med 6:2-8 [PubMed]

Systemic Inflammatory Response Syndrome (C0242966)

Definition (NCI) A generalized state of dysregulated inflammation induced by noninfectious processes. It is characterized by two or more of the following signs and symptoms: fever or hypothermia, increased heart rate, increased respiratory rate, and abnormal white blood cell count.(NICHD)
Definition (NCI_NCI-GLOSS) A serious condition in which there is inflammation throughout the whole body. It may be caused by a severe bacterial infection (sepsis), trauma, or pancreatitis. It is marked by fast heart rate, low blood pressure, low or high body temperature, and low or high white blood cell count. The condition may lead to multiple organ failure and shock.
Definition (MSH) A systemic inflammatory response to a variety of clinical insults, characterized by two or more of the following conditions: (1) fever >38 degrees C or HYPOTHERMIA <36 degrees C; (2) TACHYCARDIA >90 beat/minute; (3) tachypnea >24 breaths/minute; (4) LEUKOCYTOSIS >12,000 cells/cubic mm or 10% immature forms. While usually related to infection, SIRS can also be associated with noninfectious insults such as TRAUMA; BURNS; or PANCREATITIS. If infection is involved, a patient with SIRS is said to have SEPSIS.
Concepts Disease or Syndrome (T047)
MSH D018746
ICD9 995.90, 995.9
ICD10 R65.10
SnomedCT 238149007, 238150007
English Inflammatory Response Syndrome, Systemic, Sepsis Syndromes, Syndrome, Sepsis, Syndromes, Sepsis, Abacteraemic sepsis, SIRS - System inflam resp synd, Systemic inflam response synd, Sepsis Syndrome, SYSTEMIC INFLAMM RESPONSE SYNDROME, INFLAMM RESPONSE SYNDROME SYSTEMIC, SIRS, NOS, systemic inflammatory response syndrome (SIRS) (diagnosis), systemic inflammatory response syndrome (SIRS) due to infectious process (diagnosis), systemic inflammatory response syndrome (SIRS) due to infectious process, systemic inflammatory response syndrome (SIRS), Culture-negative sepsis, Systemic inflammatory response syndrome (SIRS) NOS, Systemic Inflammatory Response Syndrome [Disease/Finding], septic syndrome, syndrome sepsis, sepsis syndrome, Systemic Inflammatory Response Syndrome, Abacteremic sepsis, systemic inflammatory response syndrome, SIRS, SIRS - System inflammatory response syndrome, Sepsis syndrome, Septic syndrome, Systemic inflammatory response syndrome, Sepsis syndrome (disorder), Systemic inflammatory response syndrome (disorder), Systemic inflammatory response syndrome (SIRS), Systemic inflammatory response syndrome, unspecified
Italian Sindrome da risposta infiammatoria sistemica, Sindrome da sepsi, Sindrome sistemica di risposta infiammatoria, Sindrome settica, SIRS
Dutch SIRS, sepsissyndroom, systemische ontstekingsreactiesyndroom
French SIRS (syndrome de réaction inflammatoire systémique), Syndrome septique, SRIS (Systemic Inflammatory Response Syndrome), SRIG, Syndrome de réponse inflammatoire généralisée, Syndrome de réponse systémique inflammatoire, Syndrome de septicémie
German SIRS, Systemisches inflammatorisches Response-Syndrom, SIRS (Systemisches inflammatorisches Response-Syndrom), Systemisches Inflammationssyndrom, Sepsis-Syndrom, Systemic inflammatory response syndrome
Portuguese SRIS (Síndrome de Resposta Inflamatória Sistémica), Síndrome Séptica, Síndrome de Resposta Inflamatória Sistêmica, SRIS, Síndrome de Reação Inflamatória Sistêmica, Síndroma de sepsia, Síndrome de resposta inflamatória sistémica, Síndrome Reativa Inflamatória Sistêmica
Spanish SIRS, Síndrome Séptico, Síndrome de Respuesta Inflamatoria Sistémica, SRIS, síndrome de respuesta inflamatoria sistémica (trastorno), síndrome de respuesta inflamatoria sistémica, síndrome séptico (trastorno), síndrome séptico, Síndrome de respuesta inflamatoria sistémica, Síndrome séptico
Japanese SIRS, ゼンシンセイエンショウハンノウショウコウグン, SIRS, ハイケツショウショウコウグン, 炎症性反応症候群-全身性, 敗血症症候群, 全身性炎症反応症候群, 全身性炎症性反応症候群, 炎症反応症候群-全身性
Swedish Systemisk inflammatorisk respons syndrom
Finnish Systeeminen tulehduksellinen vasteoireyhtymä
Czech syndrom systémové zánětlivé odpovědi, sepse - syndrom, Syndrom systémové zánětlivé odpovědi, Septický syndrom, SIRS
Korean 상세불명의 전신 염증성 반응 증후군, 전신 염증성 반응 증후군
Polish Zespół uogólnionej odpowiedzi zapalnej, Zespół odpowiedzi ogólnoustrojowej na zakażenie, Zespół septyczny, Zespół posocznicowy, Systemowa odpowiedź zapalna, SIRS
Hungarian Systemás gyulladásos reakció syndroma, sepsis syndroma, SIRS (Systemic inflammatory response syndrome)
Norwegian Systemisk inflammatorisk respons-syndrom, SIRS
Croatian Sindrom sustavnog upalnog odgovora
Derived from the NIH UMLS (Unified Medical Language System)

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