Systemic inflammatory response syndrome

The causes of SIRS are broadly classified as infectious or noninfectious. Causes of SIRS include:

• Bacterial infections
• Severe malaria
• trauma
• burns
• pancreatitis
• ischemia
• hemorrhage

Other causes include:[1][2][3]

• Complications of surgery
• Adrenal insufficiency
• Pulmonary embolism
• Complicated aortic aneurysm
• Cardiac tamponade
• Anaphylaxis
• Drug overdose

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.[4] SIRS is also closely related to sepsis, in which patients satisfy criteria for SIRS and have a suspected or proven infection.[1][2][3][5]

Many experts consider SIRS to be overly sensitive, as nearly all (>90%) of patients admitted to the ICU meet the SIRS criteria.[6]

Generally, the treatment for SIRS is directed towards the underlying problem or inciting cause (i.e. adequate fluid replacement for hypovolemia, IVF/NPO for pancreatitis, epinephrine/steroids/diphenhydramine for anaphylaxis).[11] Selenium, glutamine, and eicosapentaenoic acid have shown effectiveness in improving symptoms in clinical trials.[12][13] Other antioxidants such as vitamin E may be helpful as well.[14]

Septic treatment protocol and diagnostic tools have been created due to the potentially severe outcome septic shock. For example, the SIRS criteria were created as mentioned above to be extremely sensitive in suggesting which patients may have sepsis. However, these rules lack specificity, i.e. not a true diagnosis of the condition, but rather a suggestion to take necessary precautions. The SIRS criteria are guidelines set in place to ensure septic patients receive care as early as possible.[15]

In cases caused by an implanted mesh, removal (explantation) of the polypropylene surgical mesh implant may be indicated.[16]

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.[17]

Criteria for SIRS were established in 1992 as part of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference.[1] The conference concluded that the manifestations of SIRS include, but are not limited to the first four described above under adult SIRS criteria.

In septic patients, these clinical signs can also be seen in other proinflammatory conditions, such as trauma, burns, pancreatitis, etc. A follow-up conference therefore decided to define the patients with a documented or highly suspicious infection that results in a systemic inflammatory response as having sepsis.[18]

Note that SIRS criteria are non-specific,[18] and must be interpreted carefully within the clinical context. These criteria exist primarily for the purpose of more objectively classifying critically ill patients so that future clinical studies may be more rigorous and more easily reproducible.