Risk Stratification in Severe Sepsis: Organ Failure Scores, PIRO or Both?

The use of all-cause hospital mortality as the sole or major endpoint for the evaluation of clinical trials in intensive care was challenged in the mid 1980s, in the aftermath of a very long series of negative clinical trials in patients with sepsis, severe sepsis, and septic shock [1]. This outcome measure, until then viewed as the golden standard in clinical trials in intensive care, is, beyond any doubt, a very relevant endpoint both for researchers and for clinicians. Its use has been contested because hospital policy can and does change the location of deaths (e.g., discharging patients to the ward to die) and mortality rates can, therefore, be significantly underestimated in hospitals that discharge patients very early in the course of their disease to other facilities [2].