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August 25, 1993

Definitions for Sepsis and Organ Failure

JAMA. 1993;270(8):939. doi:10.1001/jama.1993.03510080043022

To the Editor.  —We consider that the term systemic inflammatory response syndrome is good for pathophysiological purposes, but it should not be a substitute for the term multiple organ failure.1,2Multiple organ failure is a well-defined clinical syndrome, measurable using the APACHE II score system,3 in which systemic inflammatory response syndrome seems to be the consequence of the effects of cytokines4 and platelet activating factor5 on the microcirculation, chiefly the capillary endothelium.The factors that lead to multiple organ failure have also been observed to play different roles in diseases considered to be systemic, such as systemic lupus erythematosus and other vasculitic processes that present in similar clinical fashions, systemic inflammatory response syndrome being the common pathophysiological pathway.We believe that the term systemic inflammatory response syndrome helps us understand better the pathophysiology of the microcirculatory injury, but it has no clinical application.