The new sepsis definition

Sepsis represents the host’s systemic inflammatory response to infection.

The inflammatory response in patients with sepsis depends on the causative pathogen and the host (genetic characteristics and coexisting illnesses), with differential responses at local, regional, and systemic levels [1]. If left untreated, it may lead to the functional impairment of one or more vital organs or systems.

The third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) has recently been published [2], and updated previous classifications [3-4].

The new definition of sepsis suggests that patients with at least 2 of these 3 clinical variables: Glasgow coma scale score of 13 or less, systolic blood pressure of 100 mmHg or less, and respiratory rate 22/min or greater (quick SOFA) may be prone having the poor outcome typical of sepsis and patients with positive qSOFA should be clinically characterized as septic by SOFA score

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more. Septic shock should be defined as a subset of sepsis and should 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.The definition of severe sepsis is now superfluous.

However, some concerns about the new definition of sepsis have been reported. Since the first classification in 1991 [3], the definitions of sepsis, severe sepsis, and septic shock, though imprecise, have provided to clinicians a useful framework for clinical management, stressing the need for early recognition. The new definition of sepsis requiring the presence of organ failure has lost its predictive potential and may hinder the awareness of the importance of early recognition and treatment of sepsis, de-emphasizing intervention at earlier stages when it is most treatable and leading to a higher risk of delayed diagnosis.

Massimo Sartelli

 

 

References

  1. Angus DC, van der Poll T: Severe sepsis and septic shock. N Engl J Med. 2013, 369 (9): 840-851. 10.1056/NEJMra1208623.
  2. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10.
  3. Bone RC, Balk RA, Cerra FB, et al. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864-74.
  4. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6

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