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.
New Terms and Definitions
- Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.
- Organ dysfunction can be identified as an acute change in total Sequential Organ Failure Assessment (SOFA) score ≥ 2 points consequent to the infection.
- The baseline SOFA score can be assumed to be zero in patients not known to have preexisting organ dysfunction.
- A SOFA score ≥ 2 reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection. Even patients presenting with modest dysfunction can deteriorate further, emphasizing the seriousness of this condition and the need for prompt and appropriate intervention, if not already being instituted.
- In lay terms, sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.
- Patients with suspected infection who are likely to have a prolonged ICU stay or to die in the hospital can be promptly identified at the bedside with quick SOFA (qSOFA), ie, alteration in mental status, systolic blood pressure ≤100 mm Hg, or respiratory rate ≥22/min.
- Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.
- Patients with septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain mean arterial pressure (MAP) ≥65 mm Hg and having a serum lactate level >2 mmol/L (18 mg/dL) despite adequate volume resuscitation. With these criteria, hospital mortality is in excess of 40%.
References:
- Singer M , Deutschman CS , Seymour CW , Shankar-Hari M , Annane D , Bellomo R , Bernard GR , Chiche JD , Coopersmith CM , Hotchkiss RS ,et al . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801–10. [Medline]
- Barrier KM. Summary of the 2016 International Surviving Sepsis Campaign: A Clinician’s Guide. Crit Care Nurs Clin North Am. 2018 Sep;30(3):311-321. [Medline]
Created Jul 23, 2020.
