Sepsis and septic shock receive updated definitions
An international task force with expertise in sepsis pathobiology, clinical trials, and epidemiology released updated definitions for sepsis and septic shock this week, which were last revised in 2001.
The group was brought together by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine to redefine sepsis and septic shock in light of advances made in pathobiology, management, and epidemiology.
The new definitions, published by the Journal of the American Medical Association, are as follows:
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.
Updated clinical criteria and definitions were needed, the report said, since the multiple definitions and terminologies used beforehand led to discrepancies in reported incidences and observed mortalities. The limitations of the previous definitions included:
- Excessive focus on inflammation
- Misleading continuum that severe sepsis lead to septic shock
- Inadequate specificity of the SIRS criteria
- The use of the term severe sepsis was redundant
- Considerable medical advances have been made since the last definition update
New definitions and clinical criteria should completely replace the old information that was last updated in 2001. The new terminology will provide greater consistency for epidemiologic studies and clinical trials, and allow for earlier recognition for patients with, or at risk for developing, infection, the report said.