{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T11:03:49Z","timestamp":1774523029666,"version":"3.50.1"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2005,3,1]],"date-time":"2005-03-01T00:00:00Z","timestamp":1109635200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2005,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Rationale: The systemic inflammatory response syndrome has low specificity to identify infected patients at risk of worsening to severe sepsis or shock. Objective: To examine the incidence of and risk factors for worsening sepsis in infected patients. Methods: A 1-year inception cohort study in 28 intensive care units of patients (n = 1,531) having a first episode of infection on admission or during the stay. Measurements and main results: The cumulative incidence of progression to severe sepsis or shock was 20% and 24% at Days 10 and 30, respectively. Variables independently associated (hazard ratio [HR]) with worsening sepsis included: temperature higher than 38.2\u00b0C (1.6), heart rate greater than 120\/minute (1.3), systolic blood pressure higher than 110 mm Hg (1.5), platelets higher than 150 \u00d7 109\/L (1.5), serum sodium higher than 145 mmol\/L (1.5), bilirubin higher than 30 \u03bcmol\/L (1.3), mechanical ventilation (1.5), and five variables characterizing infection (pneumonia [HR 1.5], peritonitis [1.5], primary bacteremia [1.8], and infection with gram-positive cocci [1.3] or aerobic gram-negative bacilli [1.4]). The 12 weighted variables were included in a score (Risk of Infection to Severe Sepsis and Shock Score, range 0\u201349), summarized in four classes of \u201clow\u201d (score 0\u20138) and \u201cmoderate\u201d (8.5\u201316) risk (9% and 17% probability of worsening, respectively), and of \u201chigh\u201d (16.5\u201324) and \u201cvery high\u201d (score &amp;gt; 24) risk (31% and 55% probability, respectively). Conclusions: One of four patients presenting with infection\/sepsis worsen to severe sepsis or shock. A score estimating this risk, using objectively defined criteria for systemic inflammatory response syndrome, could be used by physicians to stratify patients for clinical management and to test new interventions.<\/jats:p>","DOI":"10.1164\/rccm.200403-324oc","type":"journal-article","created":{"date-parts":[[2004,11,5]],"date-time":"2004-11-05T20:25:22Z","timestamp":1099686322000},"page":"461-468","source":"Crossref","is-referenced-by-count":147,"title":["Systemic Inflammatory Response and Progression to Severe Sepsis in Critically Ill Infected Patients"],"prefix":"10.1093","volume":"171","author":[{"given":"Corinne","family":"Alberti","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Christian","family":"Brun-Buisson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Sylvie","family":"Chevret","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Massimo","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Sergey V.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Claudio","family":"Martin","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Rui","family":"Moreno","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Ana R.","family":"Ochagavia","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Mark","family":"Palazzo","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Karl","family":"Werdan","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]},{"given":"Jean Roger","family":"Le Gall","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Unit, Ho\u0302pital Robert Debre\u0301; Department of Medical Biostatistics, Ho\u0302pital Saint-Louis; and Medical Intensive Care Unit, Ho\u0302pital Saint-Louis, Assistance Publique\u2014Ho\u0302pitaux de Paris, Universite\u0301 Paris VII, Paris; and Medical Intensive Care Unit, Ho\u0302pital Henri-Mondor, Assistance Publique-Ho\u0302pitaux de Paris, Universite\u0301 Paris XII, Cre\u0301teil, France; Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy; General Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israe\u0308l; Critical Care-Trauma Centre, London Health Sciences Centre, London, Ontario, Canada; Intensive Care Unit, Santo Antonio dos Capuchos Hospital, Lisboa, Portugal; Intensive Care Unit, Parc Tauli Hospital, Red Gina, Spain; Intensive Care Unit, Charing Cross Hospital, London, United Kingdom; and Universitatsklinik und Poliklinik fur Innere Medizin III, Klinikum Krollwitz der Martin-Lu"}]}],"member":"286","published-online":{"date-parts":[[2005,3,1]]},"reference":[{"key":"2026032606185238000_BIB1","first-page":"1656","volume-title":"Chest","year":"1992"},{"key":"2026032606185238000_BIB2","first-page":"1303","volume-title":"Crit Care 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