—We agree with the argument that sepsis as defined by the American College of Chest Physicians—Society of Critical Care Medicine Consensus Conference1 is a form of SIRS and not specifically an initial stage of the dynamic process of infection. However, it was our hypothesis that SIRS could define the population at risk for sepsis based on the suggestions of the members of the conference. In our study, SIRS was frequently the initial stage for the subgroup of patients who subsequently developed sepsis or a more serious SIRS. More importantly, the interval to sepsis was carefully measured and was progressively shorter as more clinical criteria for SIRS were met. Such data are useful clinically.As stated by Dr Balk, some patients in the study had SIRS, and empirical antimicrobial treatment was prescribed by their physicians for presumed but never documented infection. We elected to quantify this group because they
Rangel-Frausto MS, Wenzel RP, Pittet D. The Systemic Inflammatory Response Syndrome-Reply. JAMA. 1995;274(2):127. doi:10.1001/jama.1995.03530020045022
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