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The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Published on Feb 23, 2016in JAMA51.27
· DOI :10.1001/jama.2016.0287
Mervyn Singer68
Estimated H-index: 68
(UCL: University College London),
Clifford S. Deutschman34
Estimated H-index: 34
(The Feinstein Institute for Medical Research)
+ 16 AuthorsDerek C. Angus94
Estimated H-index: 94
(University of Pittsburgh)
Cite
Abstract
Importance Definitions of 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 reexamination. Objective To evaluate and, as needed, update definitions for sepsis and septic shock. Process A task force (n = 19) with 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. Definitions and clinical criteria were generated 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 listed in the Acknowledgment). Key Findings From Evidence Synthesis Limitations of 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. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant. Recommendations Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, 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. Conclusions and Relevance These updated definitions 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.
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  • References (39)
  • Citations (2899)
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References39
Newest
Published on Feb 23, 2016in JAMA51.27
Christopher W. Seymour26
Estimated H-index: 26
(University of Pittsburgh),
Vincent Liu18
Estimated H-index: 18
(KP: Kaiser Permanente)
+ 10 AuthorsDerek C. Angus94
Estimated H-index: 94
(University of Pittsburgh)
RESULTS In the primary cohort, 148 907 encounters had suspected infection (n = 74 453 derivation; n = 74 454 validation), of whom 6347 (4%) died. Among ICU encounters in the validation cohort (n = 7932 with suspected infection, of whom 1289 [16%] died), the predictive validity for in-hospital mortality was lower for SIRS (AUROC = 0.64; 95% CI, 0.62-0.66) and qSOFA (AUROC = 0.66; 95% CI, 0.64-0.68) vs SOFA (AUROC = 0.74; 95% CI, 0.73-0.76; P < .001 for both) or LODS (AUROC = 0.75; 95% CI, 0.73-0....
Carolin Fleischmann4
Estimated H-index: 4
,
André Scherag41
Estimated H-index: 41
+ 5 AuthorsK. Reinhart77
Estimated H-index: 77
Rationale: Reducing the global burden of sepsis, a recognized global health challenge, requires comprehensive data on the incidence and mortality on a global scale.Objectives: To estimate the worldwide incidence and mortality of sepsis and identify knowledge gaps based on available evidence from observational studies.Methods: We systematically searched 15 international citation databases for population-level estimates of sepsis incidence rates and fatality in adult populations using consensus cr...
Published on Oct 15, 2015in American Journal of Respiratory and Critical Care Medicine16.49
Matthew M. Churpek18
Estimated H-index: 18
,
Frank J. Zadravecz5
Estimated H-index: 5
+ 2 AuthorsDana P. Edelson28
Estimated H-index: 28
Rationale: Tools that screen inpatients for sepsis use the systemic inflammatory response syndrome (SIRS) criteria and organ dysfunctions, but most studies of these criteria were performed in intensive care unit or emergency room populations.Objectives: To determine the incidence and prognostic value of SIRS and organ dysfunctions in a multicenter dataset of hospitalized ward patients.Methods: Hospitalized ward patients at five hospitals from November 2008 to January 2013 were included. SIRS and...
Published on Apr 23, 2015in The New England Journal of Medicine70.67
Kirsi-Maija Kaukonen17
Estimated H-index: 17
,
Michael Bailey71
Estimated H-index: 71
+ 2 AuthorsRinaldo Bellomo117
Estimated H-index: 117
BACKGROUND The consensus definition of severe sepsis requires suspected or proven infection, organ failure, and signs that meet two or more criteria for the systemic inflammatory response syndrome (SIRS). We aimed to test the sensitivity, face validity, and construct validity of this approach. METHODS We studied data from patients from 172 intensive care units in Australia and New Zealand from 2000 through 2013. We identified patients with infection and organ failure and categorized them accordi...
Published on Mar 1, 2015in Critical Care Medicine6.97
Brian Casserly8
Estimated H-index: 8
,
Gary Phillips39
Estimated H-index: 39
+ 6 AuthorsMitchell M. Levy58
Estimated H-index: 58
Objective:The Surviving Sepsis Campaign guidelines recommend obtaining a serum lactate measurement within 6 hours of presentation for all patients with suspected severe sepsis or septic shock. A lactate greater than 4 mmol/L qualifies for administration of early quantitative resuscitation therapy. W
Hector R. Wong61
Estimated H-index: 61
(UC: University of Cincinnati),
Natalie Z. Cvijanovich21
Estimated H-index: 21
(Children's Hospital Oakland Research Institute)
+ 21 AuthorsKeith Meyer20
Estimated H-index: 20
(Boston Children's Hospital)
Rationale: Using microarray data, we previously identified gene expression–based subclasses of septic shock with important phenotypic differences. The subclass-defining genes correspond to adaptive immunity and glucocorticoid receptor signaling. Identifying the subclasses in real time has theranostic implications, given the potential for immune-enhancing therapies and controversies surrounding adjunctive corticosteroids for septic shock.Objectives: To develop and validate a real-time subclassifi...
Published on Jan 1, 2015in Jacc-cardiovascular Interventions9.54
Rashmee U. Shah11
Estimated H-index: 11
(UofU: University of Utah),
Timothy D. Henry61
Estimated H-index: 61
(Cedars-Sinai Medical Center)
+ 3 AuthorsC. Noel Bairey Merz69
Estimated H-index: 69
(Cedars-Sinai Medical Center)
Abstract Objectives The aim of this study was to quantify changes in percutaneous coronary intervention (PCI) and mortality rates for ST-segment elevation myocardial infarction (STEMI), and the proportion of hospitals providing STEMI-related PCI in the United States. Background Health care systems have recently emphasized rapid access to PCI for STEMI, but the effects of these efforts in a broad population are unknown. Methods We used the Nationwide Inpatient Sample, a discharge database represe...
Published on Dec 1, 2014in Intensive Care Medicine18.97
Maurizio Cecconi30
Estimated H-index: 30
(St George's Hospital),
Daniel De Backer62
Estimated H-index: 62
(ULB: Université libre de Bruxelles)
+ 9 AuthorsJean-Louis Teboul64
Estimated H-index: 64
Objective Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock.
Published on Jul 1, 2014in Intensive Care Medicine18.97
Hafid Ait-Oufella29
Estimated H-index: 29
(UPMC: Pierre-and-Marie-Curie University),
Naïke Bigé11
Estimated H-index: 11
+ 7 AuthorsBertrand Guidet39
Estimated H-index: 39
(UPMC: Pierre-and-Marie-Curie University)
Background During septic shock management, the evaluation of microvascular perfusion by skin analysis is of interest. We aimed to study the skin capillary refill time (CRT) in a selected septic shock population.
Published on May 1, 2014in The New England Journal of Medicine70.67
Chanu Rhee13
Estimated H-index: 13
,
Shruti K. Gohil7
Estimated H-index: 7
,
Michael Klompas40
Estimated H-index: 40
The attention and resources being dedicated to improving sepsis care are welcome. The policy response to this apparent epidemic, however, ought to be tempered by recognition that we do not yet have reliable tools for measuring sepsis incidence.
Cited By2899
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Published on Jan 1, 2020in Journal of Surgical Research1.87
Jaco Suijker , Annebeth de Vries + 3 AuthorsJ.A. Halm12
Estimated H-index: 12
Abstract Background A necrotizing soft-tissue infection (NSTI) is a rare but severe infection with a high mortality rate of 12%-20%. Diagnosing is challenging and often delayed. Treatment consists of surgical debridement of all necrotic tissue and administration of antibiotics. Despite adequate treatment, survivors are often left with extensive wounds, resulting in mutilating scars and functional deficits. Both the disease and the subsequent scars can negatively influence the health-related qual...
Published on Jan 1, 2020
Julie S. Ivy11
Estimated H-index: 11
(NCSU: North Carolina State University),
Muge Capan3
Estimated H-index: 3
(Drexel University)
+ 4 AuthorsAnita R. Vila-Parrish1
Estimated H-index: 1
Decision-making to satisfy the basic human needs of health, food, and education is complex, accomplishing this in such a way that solutions are personalized to the needs of the individual has been the focus of my research. This chapter will present an overview of my research with several of my former students in the area of decision-making under conditions of uncertainty with a focus on human-centric decision problems in three primary areas: health care, humanitarian logistics, and education. Th...
Jawaid Shaw3
Estimated H-index: 3
,
Jasmohan S. Bajaj47
Estimated H-index: 47
Published on May 27, 2018in Journal of Maternal-fetal & Neonatal Medicine1.57
Agustin Iskandar1
Estimated H-index: 1
,
Maimun Z. Arthamin1
Estimated H-index: 1
+ 3 AuthorsSalvatore Di Somma28
Estimated H-index: 28
(Sapienza University of Rome)
AbstractBackground: Neonatal sepsis remains worldwide one of the leading causes of morbidity and mortality in both term and preterm infants. Lower mortality rates are related to timely diagnostic evaluation and prompt initiation of empiric antibiotic therapy. Blood culture, as gold standard examination for sepsis, has several limitations for early diagnosis, so that sepsis biomarkers could play an important role in this regard. This study was aimed to compare the value of the two biomarkers pres...
Published on Dec 1, 2019in Critical Care6.96
Hongmei Tu (CQMU: Chongqing Medical University), Xiaofei Lai5
Estimated H-index: 5
(CQMU: Chongqing Medical University)
+ 3 AuthorsJu Cao13
Estimated H-index: 13
(CQMU: Chongqing Medical University)
Sepsis is a serious syndrome that is caused by an unbalanced host inflammatory response to an infection. The cytokine network plays a pivotal role in the orchestration of inflammatory response during sepsis. IL-26 is an emerging proinflammatory member of the IL-10 cytokine family with multifaceted actions in inflammatory disorders. However, its role in the pathogenesis of sepsis remains unknown. Serum IL-26 level was measured and analyzed in 52 septic patients sampled on the day of intensive car...
Published on Apr 29, 2019in Scientific Reports4.01
Seung Mok Ryoo8
Estimated H-index: 8
(UOU: University of Ulsan),
Kap Su Han4
Estimated H-index: 4
(KU: Korea University)
+ 13 AuthorsHyung Lan Chang (Seoul National University Bundang Hospital)
The objective of this study was to evaluate the prognostic value of C-reactive protein (CRP), procalcitonin (PCT), and their combination for mortality in patients with septic shock. This multicenter, prospective, observational study was conducted between November 2015 and December 2017. A total of 1,772 septic shock patients were included, and the overall 28-day mortality was 20.7%. Although both CRP and PCT were elevated in the non-survivor group, only CRP had statistical significance (11.9 mg/...
Published on Dec 1, 2019in BMC Gastroenterology2.25
Martin Caluwaerts (UCL: Université catholique de Louvain), Diego Castanares-Zapatero8
Estimated H-index: 8
(UCL: Université catholique de Louvain)
+ 1 AuthorsPhilippe Hantson23
Estimated H-index: 23
(UCL: Université catholique de Louvain)
Background The primary endpoint was to investigate the prognostic factors of acute mesenteric ischemia (AMI) in ICU patients.
Published on Apr 17, 2019in Journal of intensive care
Martin Sebastian Winkler (GAU: University of Göttingen), Konstantin B. Märtz + 4 AuthorsMarkus H. Gräler24
Estimated H-index: 24
Background Sphingosine 1-phosphate (S1P) is a signaling lipid essential in regulating processes involved in sepsis pathophysiology, including endothelial permeability and vascular tone. Serum S1P is progressively reduced in sepsis patients with increasing severity. S1P function depends on binding to its carriers: serum albumin (SA) and high-density lipoproteins (HDL). The aim of this single-center prospective observational study was to determine the contribution of SA- and HDL-associated S1P (SA...
Published on Dec 1, 2019in Critical Care6.96
Robert Luhr (Örebro University), Yang Cao (Örebro University)+ 1 AuthorsSara Cajander3
Estimated H-index: 3
(Örebro University)
Background Epidemiologic data have shown an increasing incidence and declining mortality rate in sepsis. However, confounding effects due to differences in disease classification might have contributed to these trends. To assess if a declining mortality over time could be supported by data derived from high-quality prospective studies, we performed a meta-analysis using data from randomised controlled trials (RCTs) on sepsis. The primary aim was to assess whether the mortality in sepsis trials h...
View next paperThe SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure