Sepsis new definition

In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were published, introducing a new definition for sepsis. The new definition aims to improve the accuracy and consistency of sepsis diagnosis and treatment.

The new definition:

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.

Key components:

  1. Infection: Sepsis is caused by an infection, which can be localized or widespread.
  2. Organ dysfunction: Sepsis is characterized by organ dysfunction or failure, which can be acute or chronic.
  3. Dysregulated host response: The host's response to the infection is dysregulated, leading to a cascade of inflammatory and immune responses that can cause tissue damage and organ dysfunction.

The Sepsis-3 criteria:

To diagnose sepsis, clinicians must use the following criteria:

  1. Suspected or confirmed infection: The patient has a suspected or confirmed infection, which can be based on clinical presentation, laboratory results, or imaging studies.
  2. Acute organ dysfunction: The patient has acute organ dysfunction or failure, which can be measured using the Sequential Organ Failure Assessment (SOFA) score.
  3. Sepsis-3 criteria: The patient meets one or more of the following criteria:
    • Respiratory failure (PaO2/FiO2 ≤ 300 mmHg or mechanical ventilation).
    • Cardiovascular failure (systolic blood pressure ≤ 65 mmHg or vasopressor use).
    • Hepatic failure (bilirubin ≥ 2 mg/dL or coagulopathy).
    • Coagulopathy (international normalized ratio ≥ 1.5 or platelet count ≤ 50,000/μL).
    • Renal failure (creatinine ≥ 1.2 mg/dL or urine output ≤ 0.5 mL/kg/h).
    • Neurological failure (Glasgow Coma Scale ≤ 13 or sedation).

The SOFA score:

The SOFA score is a widely used scoring system to assess organ dysfunction in patients with sepsis. The score ranges from 0 to 24, with higher scores indicating more severe organ dysfunction.

Implications:

The new definition of sepsis aims to:

  1. Improve the accuracy of sepsis diagnosis.
  2. Enhance the consistency of sepsis treatment.
  3. Facilitate the development of targeted therapies.
  4. Reduce the use of broad-spectrum antibiotics and improve antibiotic stewardship.

Overall, the Sepsis-3 definition provides a more nuanced understanding of sepsis, emphasizing the importance of organ dysfunction and the dysregulated host response in the development of sepsis.