Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence in Acutely ill Patients (SOAP) study



To define the frequency and prognostic implications of SIRS criteria in critically ill patients hospitalized in European ICUs

Design and setting

Cohort, multicentre, observational study of 198 ICUs in 24 European countries.

Patients and interventions

All 3,147 new adult admissions to participating ICUs between 1 and 15 May 2002 were included. Data were collected prospectively, with common SIRS criteria.


During the ICU stay 93% of patients had at least two SIRS criteria [respiratory rate (82%), heart rate (80%)]. The frequency of having three or four SIRS criteria vs. two was higher in infected than non-infected patients (p < 0.01). In non-infected patients having more than two SIRS criteria was associated with a higher risk of subsequent development of severe sepsis (odds ratio 2.6, p < 0.01) and septic shock (odds ratio 3.7, p < 0.01). Organ system failure and mortality increased as the number of SIRS criteria increased.


Although common in the ICU, SIRS has prognostic importance in predicting infections, severity of disease, organ failure and outcome.

This is a preview of subscription content, log in to check access.


  1. 1.

    Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) ACCP/SCCM consensus conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874

  2. 2.

    Marik PE (2002) Definitions of sepsis: not quite time to dump SIRS? Crit Care Med 30:706–708

  3. 3.

    Vincent JL (1997) Dear SIRS, I'm sorry to say that I don't like you. Crit Care Med 25:372–374

  4. 4.

    Abraham E, Matthay MA, Dinarello CA, Vincent JL, Cohen J, Opal SM, Glauser M, Parsons P (2000) Consensus conference definitions for sepsis, septic shock, acute lung injury and acute respiratory distress syndrome. Time for reevaluation. Crit Care Med 28:232–235

  5. 5.

    Cohen J, Guyatt G, Bernard GR (2001) New strategies for clinical trials in patients with sepsis. Crit Care Med 29:880–886

  6. 6.

    Zahorec R (2000) Definitions for the septic syndrome should be reevaluated. Intensive Care Med 26:1870

  7. 7.

    Bochicchio GV, Napolitano LM, Joshi M, McCarter RJ, Scalea TM (2001) Systemic Inflammatory response syndrome score at admission independently predicts infection in blunt trauma patients. J Trauma 50:817–820

  8. 8.

    Malone DL, Kuhls D, Napolitano LM, McCarter R, Scalea TM (2001) Back to basics: validation of the admission systemic inflammatory response syndrome score in predicting outcome in trauma. J Trauma 51:458–463

  9. 9.

    Napolitano LM, Ferrer T, McCarter R, Scalea TM (2000) Systemic inflammatory response syndrome score at admission independently predicts mortality and length of stay in trauma patients. J Trauma 49:647–652

  10. 10.

    Yoshimoto Y, Tanaka T, Hoya K (2001) Acute systemic inflammatory response syndrome in subarachnoid hemorrhage. Stroke 32:1989–1993

  11. 11.

    Afessa B (1999) Systemic inflammatory response syndrome in patients hospitalized for gastrointestinal bleeding. Crit Care Med 27:554–557

  12. 12.

    Sun D, Aikawa N (1999) The natural history of the systemic inflammatory response syndrome and the evaluation of SIRS criteria as a predictor of severity in patients hospitalized through emergency services. Keio J Med 48:28–37

  13. 13.

    Asayama K, Aikawa N (1998) Evaluation of systemic inflammatory response syndrome criteria as a predictor of mortality in emergency patients transported by ambulance. Keio J Med 47:19–27

  14. 14.

    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, for the International Sepsis Definitions Conference (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definition Conference. Intensive Care Med 29:530–538

  15. 15.

    Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963

  16. 16.

    Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicentric, prospective study. Crit Care Med 26:1793–1800

  17. 17.

    Alberti C, Brun-Buisson C, Goodman SV, Guidici D, Granton J, Moreno R, Smithies M, Thomas O, Artigas A, Le Gall JR; European Sepsis Group (2003) Influence of systemic inflammatory response syndrome and sepsis on outcome in critically ill infected patients. Am J Respir Crit Care Med 168:77–84

  18. 18.

    Brun-Buisson C (2000) The epidemiology of the systemic inflammatory response. Intensive Care Med 26:S64–S74

  19. 19.

    Rangel-Frausto MS, Pittet D, Costagan M, Hwang T, Davis CS, Wenzel RP (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123

  20. 20.

    Jones GR, Lowes JA (1996) The systemic inflammatory response syndrome 1as a predictor of bacteraemia and outcome from sepsis. Q J Med 89:515–522

  21. 21.

    Alberti C, Brun-Buisson C, Chevret S, Antonelli M, Goodman SV, Martin C, Moreno R, Ochagavia AR, Palazzo M, Werdan K, Le Gall JR, European Sepsis Study Group (2005) Systemic inflammatory response and progression to severe sepsis in critically ill infected patients. Am J Respir Crit Care Med 171:461–468

  22. 22.

    Pittet D, Rangel-Frausto S, Li N, Tarara D, Costigan M, Rempe L, Jebson P, Wenzel RP (1995) Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients. Intensive Care Med 21:302–309

  23. 23.

    Bernard GR, Vincent JL, Laterre PF, La Rosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr, Recombinant Human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) Study Group (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709

  24. 24.

    Annane D, Sebille V, Charpentier C, Bollaert PE, Francois B, Korach JM, Capellier G, Cohen Y, Azoulay E, Troche G, Chaumet-Riffaut P, Bellissant E (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871

  25. 25.

    Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States1analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

Download references


This research was endorsed by the European Society for Intensive Care Medicine, and supported by an unlimited grant from Abbott, Baxter, Eli Lilly, GlaxoSmithKline and NovoNordisk.

Author information

Correspondence to Charles L. Sprung.

Additional information

On behalf of the Sepsis Occurrence in Acutely Ill Patients investigators

Endorsed by the European Society for Intensive Care Medicine, and supported by an unlimited grant from Abbott, Baxter, Eli Lilly, GlaxoSmithKline and NovoNordisk

Electronic Supplementary Material

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sprung, C.L., Sakr, Y., Vincent, J. et al. An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence in Acutely ill Patients (SOAP) study. Intensive Care Med 32, 421–427 (2006).

Download citation


  • Infections
  • Systemic inflammatory response syndrome
  • Sepsis
  • Severe sepsis
  • Septic shock
  • Prognosis