An Evaluation of Alternate Means to Diagnose Chronic Inflammatory Response Syndrome and Determine Prevalence
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Abstract
Chronic inflammatory response syndrome (CIRS) is an illness of unreported prevalence first described in 1997 (Shoemaker 1997). This study is the first reporting prevalence and evaluating alternate methods of CIRS diagnosis vs. the existing two case definitions (CD) in the literature. Both CD require improvement with therapy to confirm the diagnosis (Shoemaker and House 2006, GAO 2008). Compliance is difficult and improvement may take months. Definitive diagnosis, via CD, requires time. 1061 consecutive patients of all ages assessed at a CIRS specialty clinic were retrospectively evaluated using CD. 371 met CIRS criteria. Cluster analysis, a series of 10 lab tests and 3 screening tests were applied to these 371 patients in 4 age groups. Clusters demonstrated high sensitivity. The number of abnormal lab tests and failing 3 screening tests each demonstrated good sensitivity. Applying Clusters with Screens or Labs demonstrated excellent diagnostic accuracy with combined age group error rates ranging from 1.24 x 10 x 10-3 to 1.10 x 10-6. These approaches were applied to the 690 patients failing CD criteria. 302 additional patients achieved one or both Clusters and Screens or Labs raising the total to 673 confirmed CIRS cases. Partnership with a pediatric practice revealed 246 of these confirmed cases were from that practice yielding a minimum pediatric prevalence of 7.01%. Adult prevalence is likely even higher. At a prevalence of ≥ 7.01%, CIRS is one of the greatest public health dilemmas in existence.
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