PIRO - The PIRO sepsis concept: implementation and validation of a new classification in sepsis

  • Main research unit: CINTESIS, FMUP
  • Principal Investigator: Este endereço de email está protegido contra piratas. Necessita ativar o JavaScript para o visualizar.
  • Team:
    • Altamiro Manuel Rodrigues da Costa Pereira
    • José Alberto da Silva Freitas
    • Armando Rogério Martins Teixeira-Pinto
    • Pedro Manuel Sarmento Rodrigues Póvoa
    • João Carlos Ramos Gonçalves Pereira
    • Ana Cristina Ferreira de Sousa Lobo
  • Start date: 01.01.2009   |   End date: 31.12.2012
  • Financing: € 50.000,00 (FCT)

Project description: The definitions for SEPSIS, SEVERE SEPSIS and SEPTIC SHOCK of the last consensus conference do not allow precise characterization and staging of patients with this condition.
The PIRO concept was proposed with the 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. The development of the Q PIRO classification scheme allows the stratification of SEPSIS patients on the basis of their (P) Predisposing conditions, the nature of the (I) Insult (in case of sepsis, infection), the nature and magnitude of the host (R) Response, and the degree of concomitant (O) Organ dysfunction.
It aroused as a template for further investigation and as a work in progress to be adopted. Its elaboration requires evaluation of sepsis in order to define the variables that predict the outcome. Until now no clear PIRO models were implemented and validated.

To develop and validate a clinically useful PIRO staging system that stratifies SEPSIS, SEVERE SEPSIS, and SEPTIC SHOCK patients by the baseline risk of an adverse outcome and the potential to respond to therapy.
Creation of a clinical decision tool that predicts outcome and potential to respond to therapy.

A 17 Intensive Care Units multicentric database of variables was created regarding to SEPSIS, SEVERE SEPSIS, and SEPTIC SHOCK variables, considered to have clinical Significance. Modelling of database/data-mining is to be performed in order to find variables with clinical relevance and establish statistics significance and to create a clinical decision tool that predicts outcome in terms of mortality and quality of life and potential to respond to therapy, Further data collection will be held to complement the existent database, allowing validation of data and decision tool.

Despite the definitions for sepsis, severe sepsis, and septic shock, these terms do not allow under the current scientific knowledge precise characterization and staging of patients with these conditions, neither a prediction of the outcome.

The analogy of the system to be developed is the TNM system, developed by Pierre Denoix in 1946, that classifies malignant tumours.
A well characterized system that allows staging and prediction of outcome would largely be of benefit both for the clinician, making clinical decision on these critical patients easier and objectively supported, and for the patient as the odds would less depend on personal beliefs rather on science basis.

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