Although the true incidence is unknown, conservative estimates indicate that sepsis is a leading cause of mortality and critical illness worldwide.1 The reported incidence of sepsis is increasing likely reflecting aging populations with more comorbidities and greater recognition.1 Furthermore, there is increasing awareness that patients who survive sepsis often have long-term physical, psychological, and cognitive disabilities with significant health care and social implications.1
Since the definitions for sepsis and septic shock were last revised in 2001, considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for re-examination.1Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. Previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria.1
A taskforce of 19 critical care, infectious disease, surgical, and pulmonary specialists expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. They evaluated and updated definitions and clinical criteria for sepsis and septic shock through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement by 31 societies.1
The taskforce concluded the term severe sepsis was redundant. They recommended that sepsis should be defined as ‘life-threatening organ dysfunction caused by a dysregulated host response to infection.’ For clinical operationalisation, organ dysfunction can be represented by an increase in the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less.1
In conclusions, the experts advised that these updated definitions (Sepsis-3) and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.1
Reference: Singer, M., The Third International Consensus Definitions for Sepsis and Septic Shock, JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287 accessed from: http://jamanetwork.com/journals/jama/fullarticle/2492881 on 24/08/17
Date of Preparation: March 2018 PP-GEP-GBR-1003