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Crit Care Med. 2017 Sep;45(9):1436-1442. doi: 10.1097/CCM.0000000000002512.

The Impact of the Sepsis-3 Septic Shock Definition on Previously Defined Septic Shock Patients.

Author information

1
1Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS. 2Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.

Abstract

OBJECTIVE:

The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the "old" (1991) criteria of septic shock only.

DESIGN:

Secondary analysis of two clinical trials of early septic shock resuscitation.

SETTING:

Large academic emergency departments in the United States.

PATIENTS:

Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90 mm Hg after fluid resuscitation.

INTERVENTIONS:

Patients were further categorized as Sepsis-3 septic shock if they demonstrated hypotension, received vasopressors, and exhibited a lactate greater than 2 mmol/L. We compared in-hospital mortality in patients who met the old definition only with those who met the Sepsis-3 criteria.

MEASUREMENTS AND MAIN RESULTS:

Four hundred seventy patients were included in the present analysis. Two hundred (42.5%) met Sepsis-3 criteria, whereas 270 (57.4%) met only the old definition. Patients meeting Sepsis-3 criteria demonstrated higher severity of illness by Sequential Organ Failure Assessment score (9 vs 5; p < 0.001) and mortality (29% vs 14%; p < 0.001). Subgroup analysis of 127 patients meeting only the old definition demonstrated significant mortality benefit following implementation of a quantitative resuscitation protocol (35% vs 10%; p = 0.006).

CONCLUSION:

In this analysis, 57% of patients meeting old definition for septic shock did not meet Sepsis-3 criteria. Although Sepsis-3 criteria identified a group of patients with increased organ failure and higher mortality, those patients who met the old criteria and not Sepsis-3 criteria still demonstrated significant organ failure and 14% mortality rate.

PMID:
28542029
PMCID:
PMC5693309
DOI:
10.1097/CCM.0000000000002512
[Indexed for MEDLINE]
Free PMC Article

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