Robustness of Sepsis-3 Criteria in Critically Ill Patients

Overview

Journal J Intensive Care

Publisher Biomed Central

Specialty Critical Care

Date 2019 Sep 7

PMID 31489199

Citations 8

Authors

Diana M Verboom

Jos F Frencken

David S Y Ong

Janneke Horn

Tom van der Poll

Marc J M Bonten

Olaf L Cremer

Peter M C Klein Klouwenberg

Affiliations

Soon will be listed here.

Abstract

Background: Early recognition of sepsis is challenging, and diagnostic criteria have changed repeatedly. We assessed the robustness of sepsis-3 criteria in intensive care unit (ICU) patients.

Methods: We studied the apparent incidence and associated mortality of sepsis-3 among patients who were prospectively enrolled in the Molecular Diagnosis and Risk Stratification of Sepsis (MARS) cohort in the Netherlands, and explored the effects of minor variations in the precise definition and timing of diagnostic criteria for organ failure.

Results: Among 1081 patients with suspected infection upon ICU admission, 648 (60%) were considered to have sepsis according to prospective adjudication in the MARS study, whereas 976 (90%) met sepsis-3 criteria, yielding only 64% agreement at the individual patient level. Among 501 subjects developing ICU-acquired infection, these rates were 270 (54%) and 260 (52%), respectively (yielding 58% agreement). Hospital mortality was 234 (36%) vs 277 (28%) for those meeting MARS-sepsis or sepsis-3 criteria upon presentation ( < 0.001), and 121 (45%) vs 103 (40%) for those having sepsis onset in the ICU ( < 0.001). Minor variations in timing and interpretation of organ failure criteria had a considerable effect on the apparent prevalence of sepsis-3, which ranged from 68 to 96% among those with infection at admission, and from 22 to 99% among ICU-acquired cases.

Conclusion: The sepsis-3 definition lacks robustness as well as discriminatory ability, since nearly all patients presenting to ICU with suspected infection fulfill its criteria. These should therefore be specified in greater detail, and applied more consistently, during future sepsis studies.

Trial Registration: The MARS study is registered at ClinicalTrials.gov (identifier NCT01905033).

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References

Levy M, Fink M, Marshall J, Abraham E, Angus D, Cook D . 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med. 2003; 29(4):530-8. DOI: 10.1007/s00134-003-1662-x. View

Bone R, Balk R, Cerra F, Dellinger R, Fein A, Knaus W . Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992; 101(6):1644-55. DOI: 10.1378/chest.101.6.1644. View

Annane D, Bellissant E, Cavaillon J . Septic shock. Lancet. 2005; 365(9453):63-78. DOI: 10.1016/S0140-6736(04)17667-8. View

Calandra T, Cohen J . The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005; 33(7):1538-48. DOI: 10.1097/01.ccm.0000168253.91200.83. View

Horan T, Andrus M, Dudeck M . CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36(5):309-32. DOI: 10.1016/j.ajic.2008.03.002. View

Klein Klouwenberg P, Ong D, Bonten M, Cremer O . Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Intensive Care Med. 2012; 38(5):811-9. DOI: 10.1007/s00134-012-2549-5. View

Whittaker S, Mikkelsen M, Gaieski D, Koshy S, Kean C, Fuchs B . Severe sepsis cohorts derived from claims-based strategies appear to be biased toward a more severely ill patient population. Crit Care Med. 2013; 41(4):945-53. PMC: 3810475. DOI: 10.1097/CCM.0b013e31827466f1. View

Klein Klouwenberg P, Ong D, Bos L, de Beer F, van Hooijdonk R, Huson M . Interobserver agreement of Centers for Disease Control and Prevention criteria for classifying infections in critically ill patients. Crit Care Med. 2013; 41(10):2373-8. DOI: 10.1097/CCM.0b013e3182923712. View

Kaukonen K, Bailey M, Pilcher D, Cooper D, Bellomo R . Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015; 372(17):1629-38. DOI: 10.1056/NEJMoa1415236. View

10.

Klein Klouwenberg P, Cremer O, van Vught L, Ong D, Frencken J, Schultz M . Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Crit Care. 2015; 19:319. PMC: 4562354. DOI: 10.1186/s13054-015-1035-1. View

11.

Seymour C, Liu V, Iwashyna T, Brunkhorst F, Rea T, Scherag A . Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):762-74. PMC: 5433435. DOI: 10.1001/jama.2016.0288. View

12.

Shankar-Hari M, Phillips G, Levy M, Seymour C, Liu V, Deutschman C . Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):775-87. PMC: 4910392. DOI: 10.1001/jama.2016.0289. View

13.

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

14.

Rhee C, Kadri S, Danner R, Suffredini A, Massaro A, Kitch B . Diagnosing sepsis is subjective and highly variable: a survey of intensivists using case vignettes. Crit Care. 2016; 20:89. PMC: 4822273. DOI: 10.1186/s13054-016-1266-9. View

15.

Shankar-Hari M, Harrison D, Rowan K . Differences in Impact of Definitional Elements on Mortality Precludes International Comparisons of Sepsis Epidemiology-A Cohort Study Illustrating the Need for Standardized Reporting. Crit Care Med. 2016; 44(12):2223-2230. DOI: 10.1097/CCM.0000000000001876. View

16.

Besen B, Romano T, Nassar Jr A, Taniguchi L, Azevedo L, Mendes P . Sepsis-3 definitions predict ICU mortality in a low-middle-income country. Ann Intensive Care. 2016; 6(1):107. PMC: 5093106. DOI: 10.1186/s13613-016-0204-y. View

17.

Giamarellos-Bourboulis E, Tsaganos T, Tsangaris I, Lada M, Routsi C, Sinapidis D . Validation of the new Sepsis-3 definitions: proposal for improvement in early risk identification. Clin Microbiol Infect. 2016; 23(2):104-109. DOI: 10.1016/j.cmi.2016.11.003. View

18.

Raith E, Udy A, Bailey M, McGloughlin S, Macisaac C, Bellomo R . Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. JAMA. 2017; 317(3):290-300. DOI: 10.1001/jama.2016.20328. View

19.

Donnelly J, Safford M, Shapiro N, Baddley J, Wang H . Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study. Lancet Infect Dis. 2017; 17(6):661-670. PMC: 5449202. DOI: 10.1016/S1473-3099(17)30117-2. View

20.

Cheng B, Li Z, Wang J, Xie G, Liu X, Xu Z . Comparison of the Performance Between Sepsis-1 and Sepsis-3 in ICUs in China: A Retrospective Multicenter Study. Shock. 2017; 48(3):301-306. PMC: 5516667. DOI: 10.1097/SHK.0000000000000868. View