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.
Bibliographical noteFunding Information:
1Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS. 2Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL. This analysis was performed at the University of Mississippi Medical Center. Dr. Puskarich received support for article research from the National Institutes of Health (NIH), his institution received funding from the National Institutes of General Medical Sciences (K23GM113041), and he received funding from NIH Loan Repayment Program. Dr. Guirgis’ institution received funding from Society of Critical Care Medicine Vision Grant and from National Center for Advancing Translational Sciences through the University of Florida. Dr. Jones receives support through the National Institutes of General Medical Sciences (R01GM103799-01). The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: firstname.lastname@example.org Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DOI: 10.1097/CCM.0000000000002512
© 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
- quick Sequential Organ Failure Assessment
- sepsis definition
- septic shock