Systemic inflammatory response syndrome
| Systemic inflammatory response syndrome | |
|---|---|
| Classification and external resources | |
| Specialty | Infectious disease |
| ICD-10 | R65 |
| ICD-9-CM | 995.90 |
Systemic inflammatory response syndrome (SIRS) is an inflammatory state affecting the whole body, frequently a response of the immune system to infection.
The concept of SIRS was first conceived of and presented by Dr. William R. Nelson, of the Department of Surgery of the University of Toronto at the Nordic Micro Circulation meeting in 1983. The presentation followed a decade of research with colleagues including; Dr. J Vaage of the University of Oslo, Norway, Dr. D. Bigger, the Hospital for Sick Children, Toronto, Dr.D.Sepro of Boston University, and Dr. H Movat of the Department of Pathology at the University of Toronto. The laboratory experience was borne out in the clinical setting with Canada's first trauma unit for which Nelson was a co-founder. This allowed in the mid 1980s, the concepts of SIRS to be taught by Dr. Miles Johnson of the university of Toronto, Department of Pathology at the undergraduate dental school, as well as to residents in the Department of Surgery of the University of Toronto who rotated through the Regional Trauma Unit at Sunnybrook Medical Center. SIRS was more broadly adopted in 1991 at the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference with the goal of aiding in the early detection of sepsis. In 2016 SIRS was completely eliminated from the definition of sepsis. Many experts considered SIRS to be overly sensitive, as nearly all (>90%) of patients admitted to the ICU met the SIRS criteria.
It is the body's response to an infectious or noninfectious insult. Although the definition of SIRS refers to it as an "inflammatory" response, it actually has pro- and anti-inflammatory components.
SIRS is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of cytokine storm, in which there is abnormal regulation of various cytokines. SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection.
Manifestations of SIRS include, but are not limited to:
When two or more of these criteria are met with or without evidence of infection, patients may be diagnosed with "SIRS." Patients with SIRS and acute organ dysfunction may be termed "severe SIRS." Note: Fever and an increased white blood cell count are features of the acute-phase reaction, while an increased heart rate is often the initial sign of hemodynamic compromise. An increased rate of breathing may be related to the increased metabolic stress due to infection and inflammation, but may also be an ominous sign of inadequate perfusion resulting in the onset of anaerobic cellular metabolism.
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