systemic inflammatory response syndrome


Summary: A systemic inflammatory response to a variety of clinical insults, characterized by two or more of the following conditions: (1) fever >38 degrees C or HYPOTHERMIA <36 degrees C; (2) TACHYCARDIA >90 beat/minute; (3) tachypnea >24 breaths/minute; (4) LEUKOCYTOSIS >12,000 cells/cubic mm or 10% immature forms. While usually related to infection, SIRS can also be associated with noninfectious insults such as TRAUMA; BURNS; or PANCREATITIS. If infection is involved, a patient with SIRS is said to have SEPSIS.

Top Publications

  1. Ebrahim G. Sepsis, septic shock and the systemic inflammatory response syndrome. J Trop Pediatr. 2011;57:77-9 pubmed publisher
  2. Hotchkiss R, Coopersmith C, McDunn J, Ferguson T. The sepsis seesaw: tilting toward immunosuppression. Nat Med. 2009;15:496-7 pubmed publisher
  3. Holcomb J. A novel and potentially unifying mechanism for shock induced early coagulopathy. Ann Surg. 2011;254:201-2 pubmed publisher
  4. Sayed S, Idriss N, Sayyedf H, Ashry A, Rafatt D, Mohamed A, et al. Effects of propofol and isoflurane on haemodynamics and the inflammatory response in cardiopulmonary bypass surgery. Br J Biomed Sci. 2015;72:93-101 pubmed
    ..bypass (CPB) causes reperfusion injury that when most severe is clinically manifested as a systemic inflammatory response syndrome. The anaesthetic propofol may have anti-inflammatory properties that may reduce such a response...
  5. Vodnik T, Kaljevic G, Tadic T, Majkic Singh N. Presepsin (sCD14-ST) in preoperative diagnosis of abdominal sepsis. Clin Chem Lab Med. 2013;51:2053-62 pubmed publisher
    ..777). The ROC curve of the SIRS patient without infection and the sepsis patient showed that the presepsin concentration was a significantly sensitive indicator of sepsis and useful marker for the rapid diagnosis of sepsis. ..
  6. Franchini S, Duca A. qSOFA should replace SIRS as the screening tool for sepsis. Crit Care. 2016;20:409 pubmed publisher
  7. Vincent J, Opal S, Marshall J, Tracey K. Sepsis definitions: time for change. Lancet. 2013;381:774-5 pubmed publisher
  8. Wang L, Teng Z, Tang T, Li Z. Threshold Dynamics in Stochastic SIRS Epidemic Models with Nonlinear Incidence and Vaccination. Comput Math Methods Med. 2017;2017:7294761 pubmed publisher
    ..Finally, a series of numerical examples are introduced to illustrate our main theoretical results and some conjectures are further proposed. ..
  9. Souza Fonseca Guimaraes F, Parlato M, Philippart F, Misset B, Cavaillon J, Adib Conquy M. Toll-like receptors expression and interferon-? production by NK cells in human sepsis. Crit Care. 2012;16:R206 pubmed publisher
    ..Little is known on the immune status of NK cells in patients with systemic inflammatory response syndrome (SIRS) or sepsis in terms of cell surface markers expression and IFN-? production...

More Information


  1. Manfredi A, Rovere Querini P. The mitochondrion--a Trojan horse that kicks off inflammation?. N Engl J Med. 2010;362:2132-4 pubmed publisher
  2. Aouifi A, Piriou V, Blanc P, Bouvier H, Bastien O, Chiari P, et al. Effect of cardiopulmonary bypass on serum procalcitonin and C-reactive protein concentrations. Br J Anaesth. 1999;83:602-7 pubmed
    ..A postoperative serum PCT concentration of more than 5 ng ml-1 is highly suggestive of a postoperative complication. ..
  3. Proulx F, Fayon M, Farrell C, Lacroix J, Gauthier M. Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest. 1996;109:1033-7 pubmed
    To determine the cumulated incidence and the density of incidence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome (MODS) in critically ill children; to ..
  4. Stephan F, Méharzi D, Ricci S, Fajac A, Clergue F, Bernaudin J. Evaluation by polymerase chain reaction of cytomegalovirus reactivation in intensive care patients under mechanical ventilation. Intensive Care Med. 1996;22:1244-9 pubmed
    ..In a series of 23 critically ill patients under mechanical ventilation who were seropositive for CMV, no reactivation of CMV in blood or lung was demonstrated. ..
  5. Calfee C, Matthay M. Clinical immunology: Culprits with evolutionary ties. Nature. 2010;464:41-2 pubmed publisher
  6. Duke T, Butt W, South M. Predictors of mortality and multiple organ failure in children with sepsis. Intensive Care Med. 1997;23:684-92 pubmed
    ..Blood lactate level was the earliest predictor of outcome in children with sepsis. In this group of patients, gastric tonometry added little to the clinical information that could be derived more simply by other means. ..
  7. Brunner R, Rinner W, Haberler C, Kitzberger R, Sycha T, Herkner H, et al. Early treatment with IgM-enriched intravenous immunoglobulin does not mitigate critical illness polyneuropathy and/or myopathy in patients with multiple organ failure and SIRS/sepsis: a prospective, randomized, placebo-controlled, double-blinded tria. Crit Care. 2013;17:R213 pubmed publisher
    ..and placebo-controlled trial, 38 critically ill patients with multiple organ failure (MOF), systemic inflammatory response syndrome (SIRS)/sepsis, and early clinical signs of CIPNM were included...
  8. Huang D, Angus D, Barnato A, Gunn S, Kellum J, Stapleton D, et al. Harmonizing international trials of early goal-directed resuscitation for severe sepsis and septic shock: methodology of ProCESS, ARISE, and ProMISe. Intensive Care Med. 2013;39:1760-75 pubmed
    ..original early goal-directed therapy (EGDT) trial (suspected or confirmed infection, two or more systemic inflammatory response syndrome criteria, and refractory hypotension or elevated lactate), is powered to detect a 6–8 % ..
  9. Levi M, van der Poll T. Endothelial injury in sepsis. Intensive Care Med. 2013;39:1839-42 pubmed publisher
  10. Rattanaumpawan P, Ussavasodhi P, Kiratisin P, Aswapokee N. Epidemiology of bacteremia caused by uncommon non-fermentative gram-negative bacteria. BMC Infect Dis. 2013;13:167 pubmed publisher
    ..All patients who had at least one blood culture positive for NFGNB and met the criteria for systemic inflammatory response syndrome within 24 hours before/after obtaining the blood culture were enrolled...
  11. Martin J, Badeaux J. Interpreting Laboratory Tests in Infection: Making Sense of Biomarkers in Sepsis and Systemic Inflammatory Response Syndrome for Intensive Care Unit Patients. Crit Care Nurs Clin North Am. 2017;29:119-130 pubmed publisher
    ..No biomarkers have sufficient specificity or sensitivity to be routinely used in clinical practice, but they can aid in the diagnosis and treatment of infection versus inflammation. ..
  12. Landis R, Brown J, Fitzgerald D, Likosky D, Shore Lesserson L, Baker R, et al. Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base. J Extra Corpor Technol. 2014;46:197-211 pubmed
    ..Further research is warranted to evaluate if combinations of interventions that target multiple inflammatory pathways are capable of synergistically reducing inflammation and improving outcomes after cardiopulmonary bypass. ..
  13. Haydar S, Spanier M, Weems P, Wood S, Strout T. Comparison of QSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis. Am J Emerg Med. 2017;35:1730-1733 pubmed publisher
    ..diagnosing sepsis, as well as the diagnostic timeliness of the score when compared to traditional systemic inflammatory response syndrome (SIRS) criteria in a population of emergency department (ED) patients treated in the ED, admitted,..
  14. Goldie A, Fearon K, Ross J, Barclay G, Jackson R, Grant I, et al. Natural cytokine antagonists and endogenous antiendotoxin core antibodies in sepsis syndrome. The Sepsis Intervention Group. JAMA. 1995;274:172-7 pubmed
  15. Tompkins R. Genomics of injury: The Glue Grant experience. J Trauma Acute Care Surg. 2015;78:671-86 pubmed publisher
  16. Forceville X, Vitoux D, Gauzit R, Combes A, Lahilaire P, Chappuis P. Selenium, systemic immune response syndrome, sepsis, and outcome in critically ill patients. Crit Care Med. 1998;26:1536-44 pubmed
    ..intensive care unit (ICU), and to study this decrease according to the presence or absence of systemic inflammatory response syndrome (SIRS), sepsis, or direct ischemia-reperfusion. Prospective, observational study...
  17. Sterling S, Puskarich M, Glass A, Guirgis F, Jones A. The Impact of the Sepsis-3 Septic Shock Definition on Previously Defined Septic Shock Patients. Crit Care Med. 2017;45:1436-1442 pubmed publisher
    ..Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90?mm Hg after fluid resuscitation...
  18. Vasudevan A, Mukhopadhyay A, Li J, Yuen E, Tambyah P. A prediction tool for nosocomial multi-drug Resistant Gram-Negative Bacilli infections in critically ill patients - prospective observational study. BMC Infect Dis. 2014;14:615 pubmed publisher
    ..patients with nosocomial RGNB Infection (31bacteremia) were compared with 1398 patients with Systemic Inflammatory Response Syndrome (SIRS) without any gram negative bacterial infection/colonization admitted to the ICUs during the ..
  19. Darcy C, Minigo G, Piera K, Davis J, McNeil Y, Chen Y, et al. Neutrophils with myeloid derived suppressor function deplete arginine and constrain T cell function in septic shock patients. Crit Care. 2014;18:R163 pubmed publisher
    ..Modulation of neutrophil-MDSC or their downstream effects warrant consideration as targets for novel adjunctive therapies in sepsis. ..
  20. Rucker G, Schumacher M. Procalcitonin as a diagnostic marker for sepsis. Lancet Infect Dis. 2013;13:1012-3 pubmed publisher
  21. Vincent J, Martin G, Levy M. qSOFA does not replace SIRS in the definition of sepsis. Crit Care. 2016;20:210 pubmed publisher
  22. Yang T, Liu S, Hu J, Wang L, Jiang H. The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy. Biomed Res Int. 2017;2017:4832051 pubmed publisher
    ..A detailed clinical information and laboratory results were obtained from patients. Systemic inflammatory response syndrome (SIRS) and postoperative fever were recorded after PCNL surgery. In all, 45 cases (27...
  23. Donnelly J, Safford M, Shapiro N, Baddley J, Wang H. Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study. Lancet Infect Dis. 2017;17:661-670 pubmed publisher
    ..admissions from Feb 5, 2003, to Dec 31, 2012, and applied three classifications: infection and systemic inflammatory response syndrome (SIRS) criteria, elevated sepsis-related organ failure assessment (SOFA) score from Sepsis-3, and ..
  24. Wu B, Batech M, Quezada M, Lew D, Fujikawa K, Kung J, et al. Dynamic Measurement of Disease Activity in Acute Pancreatitis: The Pancreatitis Activity Scoring System. Am J Gastroenterol. 2017;112:1144-1152 pubmed publisher
    ..5 parameters for inclusion in the final weighted clinical activity scoring system: organ failure, systemic inflammatory response syndrome, abdominal pain, requirement for opiates and ability to tolerate oral intake...
  25. Moskowitz A, Patel P, Grossestreuer A, Chase M, Shapiro N, Berg K, et al. Quick Sequential Organ Failure Assessment and Systemic Inflammatory Response Syndrome Criteria as Predictors of Critical Care Intervention Among Patients With Suspected Infection. Crit Care Med. 2017;45:1813-1819 pubmed publisher
    ..the related predictive performance of both the quick Sequential Organ Failure Assessment and the Systemic Inflammatory Response Syndrome criteria. This was a single-center, retrospective analysis of electronic health records...
  26. Ren C, Liu Y, Cao R, Zhao T, Chen D, Yao L, et al. Colonic obstruction caused by accessory spleen torsion: A rare case report and literature review. Medicine (Baltimore). 2017;96:e8116 pubmed publisher
    ..b>Systemic inflammatory response syndrome (SIRS) was observed in this case...
  27. Xu X, Hicks C, Li Y, Su J, Shiloach J, Kaufman J, et al. Purified cell wall from the probiotic bacterium Lactobacillus gasseri activates systemic inflammation and, at higher doses, produces lethality in a rat model. Crit Care. 2014;18:R140 pubmed publisher
    ..gasseri, like other probiotic bacteria, is considered safe, its cell wall can stimulate the maladaptive inflammatory response associated with pathogenic bacteria. Such effects deserve study, especially regarding critically ill patients. ..
  28. Yamashita H, Katai H. Systemic inflammatory response in gastric cancer. World J Surg. 2010;34:2399-400 pubmed publisher
  29. Hügle T, Bircher A, Walker U. Streptococcal hypersensitivity reloaded: severe inflammatory syndrome in Behcet's disease following 23-valent polysaccharide Streptococcus pneumoniae vaccine. Rheumatology (Oxford). 2012;51:761-2 pubmed publisher
  30. Russell J, Vincent J. The new trials of early goal-directed resuscitation: three-part harmony or disharmony?. Intensive Care Med. 2013;39:1867-9 pubmed
  31. Wilson C, Seatter S, Rodriguez J, Bellingham J, Clair L, West M. In vivo endotoxin tolerance: impaired LPS-stimulated TNF release of monocytes from patients with sepsis, but not SIRS. J Surg Res. 1997;69:101-6 pubmed
    ..Septic patients are often indistinguishable from patients with systemic inflammatory response syndrome (SIRS)...
  32. Jalan R, Stadlbauer V, Sen S, Cheshire L, Chang Y, Mookerjee R. Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure: a prospective cohort study. Crit Care. 2012;16:R227 pubmed publisher
    ..A classification based on the PIRO concept may allow categorization of patients into distinct pathophysiologic and prognostic groups and allow a multidimensional definition of ACLF. ..
  33. Askim Å, Moser F, Gustad L, Stene H, Gundersen M, Åsvold B, et al. Poor performance of quick-SOFA (qSOFA) score in predicting severe sepsis and mortality - a prospective study of patients admitted with infection to the emergency department. Scand J Trauma Resusc Emerg Med. 2017;25:56 pubmed publisher
    ..The sensitivity was poorer than the other warning scores already in use at the study site, RETTS-triage and the SIRS criteria. ..
  34. Xiao T, Chen L, Zhang L, Lai F, Zhang L, Qiu Q, et al. The clinical significance of sCD14-ST for blood biomarker in neonatal hematosepsis: A diagnostic accuracy study. Medicine (Baltimore). 2017;96:e6823 pubmed publisher
    Hematosepsis is a systemic inflammatory response syndrome (SIRS) with suspected or confirmed infection, which is the most common infectious disease in clinical neonatal intensive care unit...
  35. Frauenthal V, Bergman P, Murtaugh R. Retrospective evaluation of coyote attacks in dogs: 154 cases (1997-2012). J Vet Emerg Crit Care (San Antonio). 2017;27:333-341 pubmed publisher
    ..6%. Dogs with bite wounds to the thorax had the highest mortality at 21.3%. Criteria for systemic inflammatory response syndrome (SIRS) based on admission vital signs were met in 58...
  36. Wu W, Shi Y, Gao H, Liang W, Sheng J, Li L. Immune derangement occurs in patients with H7N9 avian influenza. Crit Care. 2014;18:R43 pubmed publisher
    ..1%) with secondary respiratory infection, 20 (74%) with systemic inflammatory response syndrome (SIRS; defined as having at least two concurrent SIRS components), 18 (66...
  37. Christoffersen C, Nielsen L. Apolipoprotein M--a new biomarker in sepsis. Crit Care. 2012;16:126 pubmed publisher
    ..plasma apolipoprotein M (apoM) is affected during different grades of sepsis, septic shock and systemic inflammatory response syndrome. Interestingly, plasma apoM was significantly decreased in all groups of patients with a ..
  38. Wong H, Cvijanovich N, Hall M, Allen G, Thomas N, Freishtat R, et al. Interleukin-27 is a novel candidate diagnostic biomarker for bacterial infection in critically ill children. Crit Care. 2012;16:R213 pubmed publisher
    ..inflammation and bacterial infection in critically ill patients with fever and other signs of the systemic inflammatory response syndrome (SIRS) remains a clinical challenge...
  39. Lv R, Zhao J, Lei M, Xiao D, Yu Y, Xie J. IL-33 Attenuates Sepsis by Inhibiting IL-17 Receptor Signaling through Upregulation of SOCS3. Cell Physiol Biochem. 2017;42:1961-1972 pubmed publisher
    ..Collectively, the results suggest that IL-33 plays a negative regulatory role in sepsis progression by inhibiting IL-17 pathway through activating SOCS3. This finding would inspire a new therapeutic strategy for treating sepsis. ..
  40. Westphal M, Kampmeier T. The race against the "septic shark". Crit Care. 2015;19 Suppl 3:S11 pubmed publisher
    ..The present review discusses the current status of the systemic inflammatory response syndrome (SIRS) criteria, which are actually content for discussion because of their low specificity...
  41. Shi Y, Rui X. Procalcitonin kinetics: a reliable tool for diagnosis and monitoring of the course of bacterial infection in critically ill patients with autoimmune diseases. Intensive Care Med. 2013;39:2233-4 pubmed publisher
  42. Ala Korpela M. Serum Nuclear Magnetic Resonance Spectroscopy: One More Step toward Clinical Utility. Clin Chem. 2015;61:681-3 pubmed publisher
  43. Mikacenic C, Price B, Harju Baker S, O Mahony D, Robinson Cohen C, Radella F, et al. A Two-Biomarker Model Predicts Mortality in the Critically Ill with Sepsis. Am J Respir Crit Care Med. 2017;196:1004-1011 pubmed publisher
    Improving the prospective identification of patients with systemic inflammatory response syndrome (SIRS) and sepsis at low risk for organ dysfunction and death is a major clinical challenge.
  44. Bernabeu Wittel M, Villanueva Marcos J, de Alarcón González A, Pachon J. Septic shock and multiorganic failure in murine typhus. Eur J Clin Microbiol Infect Dis. 1998;17:131-2 pubmed
  45. Zhu Y, Li J, Yang J, Gao X, Jia H, Yang X. Inflammation-nutrition scope predicts prognosis of early-stage hepatocellular carcinoma after curative resection. Medicine (Baltimore). 2017;96:e8056 pubmed publisher
    ..The INS is a promising predictor of poor outcome in patients with HCC, especially for those with early-stage disease, and is a promising tool for HCC treatment strategy decisions for future clinical trials targeting nutritional decline. ..
  46. Wei R, Xu L, Liu J, Li Y, Zhang P, Shan B, et al. SPATA2 regulates the activation of RIPK1 by modulating linear ubiquitination. Genes Dev. 2017;31:1162-1176 pubmed publisher
    ..Spata2 deficiency sensitizes mice to systemic inflammatory response syndrome (SIRS) induced by TNFα, which can be suppressed by RIPK1 inhibitor Nec-1s...
  47. Reinhart K, Spies C, Meier Hellmann A, Bredle D, Hannemann L, Specht M, et al. N-acetylcysteine preserves oxygen consumption and gastric mucosal pH during hyperoxic ventilation. Am J Respir Crit Care Med. 1995;151:773-9 pubmed
    ..NAC, but not placebo infusion, caused a slight but significant increase in cardiac output and decrease in systemic vascular resistance.(ABSTRACT TRUNCATED AT 250 WORDS) ..
  48. Riff R, Cohen Y, Eini Rider H, Naamani O, Mazar J, Haviv Y, et al. Systemic inflammatory response syndrome-related lymphopenia is associated with adenosine A1 receptor dysfunction. J Leukoc Biol. 2017;102:95-103 pubmed publisher
    ..Interference with adenosine signaling may thus be potentially beneficial for septic patients with leukopenia. ..
    ..while anti-inflammatory cytokine concentrations decreased by day 14, increasing risk for systemic inflammatory response syndrome and multi-organ failure...
  50. Wu Y, Wang F, Fan X, Bao R, Bo L, Li J, et al. Accuracy of plasma sTREM-1 for sepsis diagnosis in systemic inflammatory patients: a systematic review and meta-analysis. Crit Care. 2012;16:R229 pubmed publisher
    ..if they assessed the accuracy of plasma sTREM-1 for sepsis diagnosis in adult patients with systemic inflammatory response syndrome (SIRS) and provided sufficient information to construct a 2 X 2 contingency table...
  51. Forceville X. The effect of selenium therapy on mortality in patients with sepsis syndrome: simple selenium supplementation or real (5 H2O)·Na2SeO3 pharmacological effect?*. Crit Care Med. 2013;41:1591-2 pubmed publisher
  52. Opal S. The current understanding of sepsis and research priorities for the future. Virulence. 2014;5:1-3 pubmed publisher
  53. Opal S, Fedson D. The dysfunctional host response to influenza A H7N9: a potential treatment option?. Crit Care. 2014;18:135 pubmed publisher
    ..Readily available, approved drugs with immune-modulating activities might prove to be a treatment option in combination with existing antiviral agents and supportive care. ..