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Intensive Care"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stratifying patients with sepsis was the basis of the predisposition, infection, response and organ dysfunction (PIRO) concept, an attempt to resolve the heterogeneity in treatment response. The purpose of this study is to perform an independent validation of the PIRO staging system in an international cohort and explore its utility in the identification of patients in whom time to antibiotic treatment is particularly important.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective international cohort study, conducted over a 6-month period in five Portuguese hospitals and one Australian institution. All consecutive adult patients admitted to selected wards or the intensive care, with infections that met the CDC criteria for lower respiratory tract, urinary, intra-abdominal and bloodstream infections were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 1638 patients included in the study. Patients who died in hospital presented with a higher PIRO score (10\u2009\u00b1\u20093 vs 8\u2009\u00b1\u20094,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). The observed mortality was 3%, 15%, 24% and 34% in stage I, II, III and IV, respectively, which was within the predicted intervals of the original model, except for stage IV patients that presented a lower mortality. The hospital survival rate was 84%. The application of the PIRO staging system to the validation cohort resulted in a positive predictive value of 97% for stage I, 91% for stage II, 85% for stage III and 66% for stage IV. The area under the receiver operating characteristics curve (AUROC) was 0.75 for the all cohort and 0.70 if only patients with bacteremia were considered. Patients in stage III and IV who did not have antibiotic therapy administered within the desired time frame had higher mortality rate than those who have timely administration of antibiotic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>To our knowledge, this is the first external validation of this PIRO staging system and it performed well on different patient wards within the hospital and in different types of hospitals. Future studies could apply the PIRO system to decision-making about specific therapeutic interventions and enrollment in clinical trials based on disease stage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13613-021-00966-7","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T14:02:55Z","timestamp":1640268175000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prospective international validation of the predisposition, infection, response and organ dysfunction (PIRO) clinical staging system among intensive care and general ward patients"],"prefix":"10.1016","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2451-4260","authenticated-orcid":false,"given":"T.","family":"Cardoso","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7867-6682","authenticated-orcid":false,"given":"P. 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Ethics and Institutional Review Board approval was obtained for all participating sites: Centro Hospitalar Universit\u00e1rio do Porto (2014.147-CES), Unidade Local de Sa\u00fade do Nordeste (25\/07\/2014), Hospital de Braga (14\/10\/2014), Unidade Local de Sa\u00fade de Matosinhos (2014 \u2013 073\/CE\/JAS), Centro Hospitalar de S\u00e3o Jo\u00e3o (CES 249-14) and Barwon Health (14\/131).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Informed consent was waived due to the observational nature of the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have no conflicts of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"180"}}