Systemic inflammatory response syndrome (SIRS) is an exaggerated defense response of the body to a noxious stressor to localize and then eliminate the endogenous or exogenous source of the insult. It is a clinical syndrome characterized by systemic inflammation and widespread tissue injury and can be defined by several clinical variables including temperature >38°C or <35°C, heart rate >90 beats/min, respiratory rate >20 breaths/min or PCO2 < 32 mmHg, and WBC > 12000 cells/mm or <4000 cells/mm.

It involves the release of acute-phase reactants which are direct mediators of widespread autonomic, endocrine, hematological and immunological alteration in the subject. Even though the purpose is defensive, the dysregulated cytokine storm has the potential to cause massive inflammatory cascade leading to reversible or irreversible end-organ dysfunction and even death.

SIRS can result from insults such as trauma, thermal injury, pancreatitis, autoimmune disorders, and surgery. When SIRS occurs as a result of infection, it is termed sepsis. Sepsis came to be defined as presence or presumed presence of infection accompanied by evidence of SIRS. Severe sepsis is present when sepsis is accompanied by organ hypoperfusion or dysfunction of one or more organs such as acute renal failure, thrombocytopenia or disseminated intravascular coagulation (DIC), jaundice, acute respiratory distress or delirium. Hypotension refractory to intravenous fluid in the presence of sepsis signifies septic shock.

Despite having a relatively common physiologic pathway, numerous triggers exists for SIRS and patients present in a variety of manners. A thorough history is critical in determining the proper evaluation of the patient with SIRS as the differential diagnosis is extremely broad. The clinician’s history should be focused around the chief complaint with a pertinent review of systems. Patients should be questioned regarding constitutional symptoms of fever, chills and night sweats which may help differentiate infectious from noninfectious etiologies.

The occurrence of SIRS is very high, affecting one-third of all in-hospital patients, and >50% of all ICU patients; in surgical ICU patients, SIRS occurs in >80% patients. Trauma patients are at particularly high risk of SIRS, and most these patients do not have infection documented.

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