New SCCM Consensus Definitions for Sepsis and Septic Shock

By Dr Deepu

A critical care task force has proposed a new definition for sepsis and septic shock based on advances in science and the testing of clinical criteria against patient outcomes in EHR data. Find the link to download the full article from JAMA at the end.
The new definition for sepsis includes evidence for infection, plus life-threatening organ dysfunction, which is clinically characterized by an acute change of two points or greater on the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score.
Septic shock is now defined to include sepsis with fluid-unresponsive hypotension, serum lactate level greater than 2 mmol/L, and the need for vasopressors to maintain mean arterial pressure of 65 mm Hg or greater.

The new definitions do away with the current use of two or more systemic inflammatory response syndrome (SIRS) criteria for sepsis diagnosis. Components of SIRS include tachycardia, tachypnea, hyperthermia or hypothermia, and elevated white blood count.

   Led by Mervyn Singer, MD, of University College London, and Clifford Deutschman, MD, MS, of Hofstra-Northwell School of Medicine in New Hyde Park, N.Y., the international task force that developed the new definitions unanimously considered the requirement for two or more SIRS criteria to be unhelpful in the diagnosis of sepsis.

       They conducted a study to examine the validity of the revised sepsis definitions in a cohort of 148,907 suspected sepsis infections.
Their analysis identified a rapid method for identifying suspected sepsis outside the critical care hospital setting which includes two or more of the following clinical criteria: respiratory rate of 22/min or greater, altered mentation or systolic blood pressure of 100 mm Hg or less.
The bedside clinical scoring system is known as "quick SOFA" or qSOFA.
It is endorsed by SCCM, the American Thoracic Society, the European Respiratory Society, and the European Society of Intensive Care Medicine and related organizations in Africa, Asia, South America, and the Middle East.

The Task Force now recommends that sepsis and septic shock be defined as follows:
  • Definitions:
Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection
Septic shock: Sepsis with circulatory and cellular/metabolic abnormalities profound enough to substantially increase mortality

  • Clinical Criteria:
Sepsis: Suspected or documented infection and an acute increase of ≥ 2 SOFA points (a proxy for organ dysfunction)

Septic Shock: Sepsis and vasopressor therapy needed to elevate MAP ≥ 65 mmg Hg and lactate > 2 mmol/L (18 mg/dL) after adequate fluid resuscitation

Download the Full article from JAMA