By Dr Deepu
A critical care task
force has proposed a new definition for sepsis and septic shock based on
advances in science and the testing of clinical criteria against patient
outcomes in EHR data. Find the link to download the full article from JAMA at the end.
The
new definition for sepsis includes evidence for infection, plus
life-threatening organ dysfunction, which is clinically characterized by an
acute change of two points or greater on the Sequential [Sepsis-related] Organ
Failure Assessment (SOFA) score.
Septic
shock is now defined to include sepsis with fluid-unresponsive hypotension,
serum lactate level greater than 2 mmol/L, and the need for vasopressors to
maintain mean arterial pressure of 65 mm Hg or greater.
The
new definitions do away with the current use of two or more systemic
inflammatory response syndrome (SIRS) criteria for sepsis diagnosis. Components
of SIRS include tachycardia, tachypnea, hyperthermia or hypothermia, and
elevated white blood count.
Led
by Mervyn Singer, MD, of University College London, and Clifford Deutschman,
MD, MS, of Hofstra-Northwell School of Medicine in New Hyde Park, N.Y., the
international task force that developed the new definitions unanimously
considered the requirement for two or more SIRS criteria to be unhelpful in the
diagnosis of sepsis.
They
conducted a study to examine the validity of the revised sepsis definitions in
a cohort of 148,907 suspected sepsis infections.
Their
analysis identified a rapid method for identifying suspected sepsis outside the
critical care hospital setting which includes two or more of the following
clinical criteria: respiratory rate of 22/min or greater, altered mentation or
systolic blood pressure of 100 mm Hg or less.
The
bedside clinical scoring system is known as "quick SOFA" or qSOFA.
It
is endorsed by SCCM, the American Thoracic Society, the European Respiratory
Society, and the European Society of Intensive Care Medicine and related
organizations in Africa, Asia, South America, and the Middle East.
The Task Force now
recommends that sepsis and septic shock be defined as follows:
- Definitions:
Sepsis: Life-threatening organ dysfunction caused by a
dysregulated host response to infection
Septic shock: Sepsis
with circulatory and cellular/metabolic abnormalities profound enough to
substantially increase mortality
- Clinical Criteria:
Sepsis: Suspected or documented infection and an acute increase
of ≥ 2 SOFA points (a proxy for organ dysfunction)
Septic Shock: Sepsis
and vasopressor therapy needed to elevate MAP ≥ 65 mmg Hg and lactate > 2
mmol/L (18 mg/dL) after adequate fluid resuscitation
Download the Full article from JAMA
Download the Full article from JAMA