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Fast Five Quiz: How Much Do You Know About Systemic Inflammatory Response Syndrome?

Michael R. Pinksy, MD, CM, Dr(HC), FCCP, MCCM

February 12, 2018

In 1992, the American College of Chest Physicians and the Society of Critical Care Medicine introduced definitions for systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome. The idea behind defining SIRS was to define a clinical response to a nonspecific insult of either infectious or noninfectious origin. SIRS is defined as two or more of the following variables:

  • Fever of more than 100.4°F (38°C) or less than 96.8°F (36°C)
  • Heart rate of more than 90 beats/min
  • Respiratory rate of more than 20 breaths/min or arterial carbon dioxide tension of less than 32 mmHg
  • Abnormal white blood cell count (> 12,000/µL or < 4000/µL or > 10% immature [band] forms)

SIRS is nonspecific and can be caused by ischemia, inflammation, trauma, infection, or several insults combined. Thus, SIRS is not always related to infection. Although sepsis has diverged from SIRS criteria for diagnosis and management in recent years, focusing more on infectious etiologies, the pathophysiologic processes present in sepsis and noninfectious SIRS are remarkably similar, making a discussion of SIRS in critical illness appropriate.

Are you familiar with the background and presentation of SIRS, as well as key aspects of workup and treatment? Test yourself with this quick quiz.

Question 1: Which of the following is accurate about SIRS?

Answer 1: SIRS only develops when a localized aggressive injury process gains access to the whole body through the blood stream and lymphatics

Inflammation is an essential component of host defense and serves a very strongly positive survival function in suppressing and then eliminating local infection and tissue injury. It is only when a localized aggressive injury process gains access to the whole body through the blood stream and lymphatics that SIRS develops. Independent of the etiology, SIRS has the same pathophysiologic properties, with minor differences in inciting cascades. Many consider the syndrome a self-defense mechanism.

Women tend to have less inflammation from the same degree of proinflammatory stimuli due to the mitigating aspects of estrogen. The reasons for this are not completely known, but estrogen sustains adrenergic receptor activity in inflammation, when, in its absence, adrenergic receptor downregulation occurs. Thus, premenopausal women tend to have less vasoplegia and respond more vigorously to resuscitation efforts. This equates to women having a 10-year age benefit over men.

The true incidence of SIRS is unknown but probably very high, owing to the nonspecific nature of its definition. Not all patients with SIRS require hospitalization or have diseases that progress to serious illness. Indeed, patients with a seasonal head cold due to rhinovirus usually fulfill the criteria for SIRS. Because SIRS criteria are nonspecific and occur in patients who present with conditions ranging from influenza to cardiovascular collapse associated with severe pancreatitis, any incidence figures must be stratified based on SIRS severity.

For more on SIRS, read here.

Which of the following is accurate about the presentation and physical examination findings associated with SIRS?

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