The systemic inflammatory response syndrome and sequential organ failure assessment scores are effective triage markers following paracetamol (acetaminophen) overdose

Aliment Pharmacol Ther 2011; 34: 219–228 Summary Background The systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores are widely used as prognostic markers in critical care settings and could improve triage of high‐risk paracetamol (acetaminophen) overdose patients. Aim To evaluate the prognostic accuracy of the SIRS and SOFA scores following single time point paracetamol overdose. Methods Analysis of 100 single time point paracetamol overdoses admitted to a tertiary liver centre, with subsequent prospective validation of identified thresholds. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post‐overdose, and the daily SOFA and SIRS scores calculated. Results A total of 74 (74%) patients developed the SIRS, which occurred significantly earlier in patients who died (n = 21) compared with spontaneous survivors (n = 53, P = 0.05). The SIRS occurred in 70 (70%) patients by 96 h post‐overdose, with a 30% mortality rate; compared with 0% mortality in the 30 non‐SIRS patients (P = 0.001). Median SOFA scores were significantly higher in nonsurvivors at 48 (P = 0.009), 72 (P 7 or a SIRS response during the first 96 h following paracetamol overdose could improve triage and reduce transfers of lower risk patients to tertiary liver centres.