Redefinitions of Sepsis and Septic Shock Aim to Increase Early Detection
Sepsis is the primary cause of death from infection, the third leading cause of death overall in the U.S., and is considered the most expensive condition treated in the nation's hospitals, costing more than $20 billion in 2011. Its reported incidence is also on the rise.
"Since considerable advances have been made to the pathophysiology, management, and epidemiology of sepsis, there was a need for re-examination of sepsis and septic shock," says Craig Coopersmith, MD, vice chair of research of the Emory Department of Surgery and associate director of the Emory Critical Care Center. "Better defining these two conditions will help us treat patients in a more timely fashion, plus offer greater consistency for epidemiological studies and clinical trials."
Dr. Coopersmith was a member of an international task force of experts convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine to redefine the terms "sepsis" and "septic shock" to facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis. Definitions of sepsis and septic shock were last revised in 2001 (Sepsis-2) and 1991 (Sepsis-1). Greg Martin, MD, MSc, director of research of the Emory Critical Care Center, also served on the task force.
Dr. Coopersmith was the president of the Society of Critical Care Medicine during this period. He is now immediate past president of the organization.
The group spent one year reviewing large data sets of hospitalized patients with presumed infection, assessing the simplest and most accurate ways to determine which patients have sepsis. Once definitions were updated, they were circulated to international professional societies, requesting peer review and endorsement. The recommendations were published in the February 2016 issue of JAMA and highlighted for clinicians and media at the Society of Critical Care Medicine's 45th Critical Care Congress in Orlando, Florida.
The new recommendations define sepsis — now known as Sepsis-3 — as life-threatening organ dysfunction due to a dysregulated host response to infection, and describe septic shock as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities substantially increase mortality. In order to assist physicians in more quickly identifying patients with or at risk of developing these conditions, these redefinitions offer more specificity and plot a clear and consistent roadmap for diagnosing, reporting, and treating Sepsis-3.
With organ dysfunction denoted as the primary threshold that elevates uncomplicated infection to sepsis, the task force devised a simple method to assess for organ dysfunction that relies on examining respiratory rate, mental status, and blood pressure. Named the Sequential (Sepsis-Related) Organ Failure Assessment, or quickSOFA (qSOFA), the new diagnostic tool can be used in physicians' offices, emergency departments, and hospital wards to quickly establish patients at risk for sepsis.
"These updated definitions and clinical criteria should clarify long-used descriptors and bring about earlier recognition of patients at risk of developing sepsis," explains Dr. Coopersmith. "But the process remains a work in progress, and new diagnostic approaches and enhanced collection of data will fuel their continued re-evaluation and revision."
This work was supported in part by a grant from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine.