Sepsis certainly keeps us going... either when treating patients on ICU or when it comes to the discussion on what actually sepsis is and how to define it. So far the SIRS (Systemic Inflammatory Response Syndrome) criteria have provided some degree of handle to cope with this syndrome but of course we weren't all quite happy with this. In fact every person with any sort of infectious disease will respond with 2 or more SIRS criteria... but doesn't necessarily have to be septic. As a matter of fact a SIRS is nothing else but a physiologic response to any sort of inflammation.
The New Approach to Sepsis - The SOFA
The new international consensus definitions for sepsis and septic shock try to focus on the fact that sepsis itself defines a life-threatening organ dysfunction caused by a dysregulated host response to infection. By saying this the aim is to provide a definition that allows early detection of septic patients and allow prompt and appropriate response. As even a modest degree of organ dysfunction is associated with an increased in-hospital mortality the SOFA score (Sequential or 'Sepsis-related' Organ Failure Assessment) was found to be the best scoring system for this purpose. It's well known, simple to use and has a well-validated relationship to mortality risk.
Sepsis (related organ dysfunction) is now defined by a SOFA score increase of 2 points or more
The Quick Approach to Sepsis - The BAT
In the out-of-hospital setting, on the general wards or in the emergency department the task force recommends an altered bed side clinical score called the quickSOFA - or alternatively 'the BAT' score:
The New Approach to Septic Shock -Vasopressors and Lactate
Septic shock is now defined as a subset of sepsis in which underlying circulatory, cellular, and metabolic abnormalities are associated with a greater risk of death than sepsis alone. Keeping a long story short:
Septic Shock is now:
- The need for vasopressors to maintain a mean arterial pressure of at least 65mmHg
- a serum lactate level of more than 2mmol/L... after adequate fluid resuscitation
The Bottom Line:
The way it looks like we are left with Sepsis and Septic Shock
Severe Sepsis has vanished and the question remains, whether these new definitions will actually benefit the ones that need it most... our septic patients!
Singer M et al. JAMA. 2016;315(8):801-810.
Seymour CW et al. JAMA. 2016;315(8):762-774.
Shankar-Hari M et al. JAMA. 2016;315(8):775-787.