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The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
JAMA 2016; 315(8):801-10JAMA

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.

Authors+Show Affiliations

Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom.Hofstra-Northwell School of Medicine, Feinstein Institute for Medical Research, New Hyde Park, New York.Department of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.Department of Critical Care Medicine, University of Versailles, France.Center for Sepsis Control and Care, University Hospital, Jena, Germany.Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, and Austin Hospital, Melbourne, Victoria, Australia.Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University, Nashville, Tennessee.Réanimation Médicale-Hôpital Cochin, Descartes University, Cochin Institute, Paris, France.Critical Care Center, Emory University School of Medicine, Atlanta, Georgia.Washington University School of Medicine, St Louis, Missouri.Infectious Disease Section, Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, Rhode Island.Department of Surgery, University of Toronto, Toronto, Ontario, Canada.Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia.Infectious Disease Section, Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, Rhode Island.Trauma, Emergency & Critical Care Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada16Interdepartmental Division of Critical Care, University of Toronto.Department of Infectious Diseases, Academisch Medisch Centrum, Amsterdam, the Netherlands.Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.Department of Critical Care Medicine, University of Pittsburgh and UPMC Health System, Pittsburgh, Pennsylvania20Associate Editor, JAMA.

Pub Type(s)

Consensus Development Conference
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26903338

Citation

Singer, Mervyn, et al. "The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)." JAMA, vol. 315, no. 8, 2016, pp. 801-10.
Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., ... Angus, D. C. (2016). The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 315(8), pp. 801-10. doi:10.1001/jama.2016.0287.
Singer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. PubMed PMID: 26903338.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). AU - Singer,Mervyn, AU - Deutschman,Clifford S, AU - Seymour,Christopher Warren, AU - Shankar-Hari,Manu, AU - Annane,Djillali, AU - Bauer,Michael, AU - Bellomo,Rinaldo, AU - Bernard,Gordon R, AU - Chiche,Jean-Daniel, AU - Coopersmith,Craig M, AU - Hotchkiss,Richard S, AU - Levy,Mitchell M, AU - Marshall,John C, AU - Martin,Greg S, AU - Opal,Steven M, AU - Rubenfeld,Gordon D, AU - van der Poll,Tom, AU - Vincent,Jean-Louis, AU - Angus,Derek C, PY - 2016/2/24/entrez PY - 2016/2/24/pubmed PY - 2016/3/2/medline SP - 801 EP - 10 JF - JAMA JO - JAMA VL - 315 IS - 8 N2 - 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. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/26903338/full_citation L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.0287 DB - PRIME DP - Unbound Medicine ER -