The Impact of the Sepsis-3 Septic Shock Definition on Previously Defined Septic Shock Patients*
- 1 September 2017
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Critical Care Medicine
- Vol. 45 (9), 1436-1442
- https://doi.org/10.1097/ccm.0000000000002512
Abstract
Objective: The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the “old” (1991) criteria of septic shock only. Design: Secondary analysis of two clinical trials of early septic shock resuscitation. Setting: Large academic emergency departments in the United States. Patients: Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90 mm Hg after fluid resuscitation. Interventions: Patients were further categorized as Sepsis-3 septic shock if they demonstrated hypotension, received vasopressors, and exhibited a lactate greater than 2 mmol/L. We compared in-hospital mortality in patients who met the old definition only with those who met the Sepsis-3 criteria. Measurements and Main Results: Four hundred seventy patients were included in the present analysis. Two hundred (42.5%) met Sepsis-3 criteria, whereas 270 (57.4%) met only the old definition. Patients meeting Sepsis-3 criteria demonstrated higher severity of illness by Sequential Organ Failure Assessment score (9 vs 5; p < 0.001) and mortality (29% vs 14%; p < 0.001). Subgroup analysis of 127 patients meeting only the old definition demonstrated significant mortality benefit following implementation of a quantitative resuscitation protocol (35% vs 10%; p = 0.006). Conclusion: In this analysis, 57% of patients meeting old definition for septic shock did not meet Sepsis-3 criteria. Although Sepsis-3 criteria identified a group of patients with increased organ failure and higher mortality, those patients who met the old criteria and not Sepsis-3 criteria still demonstrated significant organ failure and 14% mortality rate.Keywords
This publication has 23 references indexed in Scilit:
- Systemic Inflammatory Response Syndrome Criteria in Defining Severe SepsisThe New England Journal of Medicine, 2015
- Two Decades of Mortality Trends Among Patients With Severe SepsisCritical Care Medicine, 2014
- Characteristics and Outcomes of Patients With Vasoplegic Versus Tissue Dysoxic Septic ShockShock, 2013
- Update in Sepsis 2012American Journal of Respiratory and Critical Care Medicine, 2013
- Multicenter Observational Study of the Development of Progressive Organ Dysfunction and Therapeutic Interventions in Normotensive Sepsis Patients in the Emergency DepartmentAcademic Emergency Medicine, 2013
- 30-Day Risk-Standardized Mortality and Readmission Rates After Ischemic Stroke in Critical Access HospitalsStroke, 2012
- Massive Pulmonary EmbolismCirculation, 2006
- The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational studyCritical Care, 2005
- 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions ConferenceCritical Care Medicine, 2003
- Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care unitsCritical Care Medicine, 1998