How to differentiate between moderate and severe infection? The answer is SIRS

SIRS Is Valid in Discriminating Between Severe and Moderate Diabetic Foot Infections

  1. Dane K. Wukich, MD1,
  2. Kimberlee B. Hobizal, DPM2,
  3. Katherine Marie Raspovic, DPM2and
  4. Bedda L. Rosario, PHD3

  1. 1University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center Mercy Center for Healing and Amputation Prevention, Pittsburgh, Pennsylvania

  2. 2Center for Healing and Amputation Prevention, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Mercy Foot and Ankle Program, Pittsburgh, Pennsylvania

  3. 3University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
  1. Corresponding author: Dane K. Wukich,


OBJECTIVE This retrospective, single-center study was designed to distinguish severe diabetic foot infection (DFI) from moderate DFI based on the presence or absence of systemic inflammatory response syndrome (SIRS).

RESEARCH DESIGN AND METHODSThe database of a single academic foot and ankle program was reviewed and 119 patients were identified. Severe DFI was defined as local infection associated with manifestation of two or more objective findings of systemic toxicity using SIRS criteria.

RESULTS Patients with severe DFI experienced a 2.55-fold higher risk of any amputation (95% CI 1.21–5.36) and a 7.12-fold higher risk of major amputation (1.83–41.05) than patients with moderate DFI. The risk of minor amputations was not significantly different between the two groups (odds ratio 1.02 [95% CI 0.51–2.28]). The odds of having a severe DFI was 7.82 times higher in patients who presented with gangrene (2.03–44.81) and five times higher in patients who reported symptoms of anorexia, chills, nausea, or vomiting (2.22–11.25). The mean length of stay for patients with severe DFI was ∼4 days longer than for patients with moderate DFI, and this difference was statistically significant.

CONCLUSIONS SIRS is valid in distinguishing severe from moderate DFI in hospitalized patients. Patients with severe DFI, as by manifesting two or more signs of systemic inflammation or toxicity, had higher rates of major amputation and longer hospital stays and required more surgery and more subsequent admissions than patients who did not manifest SIRS.

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