Management and Outcomes of SIRS-Negative Versus SIRS-Positive Sepsis

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Rationale: Systemic inflammatory response syndrome (SIRS) criteria were removed from the Sepsis-3 definition since they do not distinguish simple infection from sepsis. However, SIRS remains widely used for sepsis screening. We sought to examine the prevalence, management, and outcomes of patients with community-onset sepsis who are SIRS-negative vs SIRS-positive at hospital presentation, to understand the potential implications of SIRS-based screening for sepsis. Methods: We conducted a retrospective cohort study of adult patients hospitalized with community-onset sepsis at 68 hospitals participating in the Michigan Hospital Medicine Safety Consortium’s sepsis initiative (HMS-Sepsis) from 2020-2025. HMS is funded by Blue Cross Blue Shield of Michigan. Professional abstractors at each hospital enter data on a random sample of hospitalizations for community-onset sepsis into a centralized registry using standardized data definitions. Patients with sepsis are identified via a two-step process. First, hospitalizations with principal diagnostic codes for sepsis, infection, or acute respiratory failure are identified. Second, these hospitalizations are screened for clinical evidence of infection and acute organ dysfunction during the first two encounter days to confirm they meet surveillance criteria for sepsis. SIRS-negative (0-1 SIRS criteria) patients were compared to SIRS-positive (2-4 SIRS criteria) patients across demographic characteristics, comorbidities, illness severity, adherence to early sepsis management guidelines, and clinical outcomes. Results: Among 52,880 patients hospitalized with community-onset sepsis during the study period, 5,710 (10.8%) were SIRS-negative at initial hospital presentation. Compared to SIRS-positive patients SIRS-negative patients were older (median age, 75 vs 71 years, p < 0.0001), had more chronic comorbidities and functional limitations, and were less acutely ill (e.g., lactate 1.5 vs 2.1; ICU admission 18.3% vs 24.6%; both p < 0.0001). SIRS-negative patients were also less likely to receive indicated early sepsis care (Figure), including lactate measurement (58.3% vs 75.7%, p < 0.0001), blood culture collection (53.0% vs 72.6%, p < 0.0001), timely antibiotic administration (57.7% vs 76.7%, p < 0.0001), and fluid resuscitation (51.3% vs 63.0%, p < 0.0001). SIRS-negative patients had higher risk-adjusted 30-day mortality (18.7% vs 17.5%, absolute risk difference 1.2% [95% CI 0.3% to 2.2%], p = 0.01). Conclusions: About 1 in 10 patients with community-onset sepsis present without meeting SIRS criteria and are less likely to receive timely sepsis care. These findings suggest that continued reliance on SIRS-based screening protocols may delay sepsis recognition and management in vulnerable patients, contributing to worse risk-adjusted outcomes. Updating hospital sepsis screening approaches to identify at-risk patients beyond SIRS criteria is necessary to improve early recognition and treatment for all patients with sepsis.

Volume

212

Issue

S1

First Page

S4622

Last Page

S4622

Comments

American Thoracic Society International Conference, May 15-20, 2026, Orlando, FL

DOI

10.1093/ajrccm/aamag162.6195

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