Dear Colleague,
We woulkd like to invite you to participate in the PIRO II Study, a confirmatory
study of a previous study – The Predisposition, Infection, Response and Organ Failure
(Piro) Sepsis Classification System: Results of Hospital Mortality Using a Novel
Concept and Methodological Approach, which was published on PLOS ONE in 2013
(PLoS ONE 8(1): e53885. doi:10.1371/journal.pone.0053885) and
that you will find in annexe
to this file.
The PIRO concept, which describes septic patients across four domains, aroused
with the suggestion that sepsis could be looked in a similar way to cancer, with the
TNM staging system. This system suggested that patients could be stratified on the
basis of their predisposing conditions, the nature and extent of the insult (infection),
the nature and magnitude of the host response, and the degree of organ dysfunction.
However, describing sepsis-associated organ dysfunction in light of the PIRO system
and introducing it in everyday practice has been challenging.
The purpose of our first study was to to identify for each component of PIRO the
specific variables associated with higher ability to predict hospital mortality,
including a dynamic assessment of variables of the PIRO classification system.
It was a large multicenter study that included 17 Portuguese Intensive Care Units in
Portugal and nearly 900 patients. In our first study we identified specific variables
associated with each of the four components of PIRO, including biomarkers and a
dynamic view of the patient daily clinical course. This novel approach to PIRO
concept and overall score could be a better predictor of mortality for patients with
community-acquired sepsis admitted to ICUs. Our results showed that this novel
approach to PIRO concept present a good prediction of hospital mortality for patients
with community-acquired sepsis admitted to ICUs. It is also our believe that PIRO
system should be further investigated in order to become a true patient staging system
with real treatment and prognostic implications in sepsis patients.
We are now inviting several Swedish ICUs to perform a confirmatory study from that
previous study.
I am contacting you to encourage you to participate with your ICU in the PIRO II
Study. The findings of this study will substantially enhance our knowledge towards a
future consense and may impulsionate a step further in trying to find out which model
with which variables may best fit on a tool able to give us, clinicians, information
concerning the prognosis and treatment response of severe sepsis and septic shock
On annexe you will find the study protocol, the data collection form and further
information.
Unfortunately, we are unable to provide any economic support for participating
centers. However, once results from the study will be published each participating
center and its lead investigator will be named as a collaborator on the published
manuscript.
I look forward your participation in PIRO II Study. Please do not hesitate to contact
me if any additional information is required.
Cristina Granja, M.D., PhD.
Study Coordinator
ICU Director, Emergency and Intensive Care Department, Centro Hospitalar Algarve
Associate Professor of Medicine, University of Algarve
Affiliate Professor CIDES/CINTESIS - Faculty of Medicine of Porto, Portugal
Phone +351912206712
Email: cristinagranja@hotmail.com