Sepsis-2 vs Sepsis-3: The One Size Fits All Approach is Over

Summary
  • There is no gold stand definition for sepsis.

  • Sepsis-2 definition captures a high level of inflammation, whereas Sepsis-3 definition is associated with a higher risk of death.
  • Most ICU patients with infection meet both Sepsis-2 and Sepsis-3 definitions
  • Better criteria are needed which incorporates, vital signs, comorbidities, clinical picture, immune response and treatment response.
Background

Sepsis is difficult to identify with patients expressing different symptoms based on the interaction between the infection caused inflammatory response and the patients hosts factors. The evolution of the definition of sepsis from versions Sepsis-2 to Sepsis-3 were designed to improve risk stratification of patients with suspected infection and organ failure.

Review

A recent study (Sepsis Prognostication in Intensive Care Unit and Emergency Room (SPICE-ICU) evaluated the characteristics of patients who met Sepsis-2 and Sepsis-3 criteria (Abe et al Journal of Critical Care 2020;8:44 open access)

  • 22 ICU’s in Japan
  • 618 adult patients with suspected infection
  • Each patient was assessed with published Sepsis-2 and Sepsis-3 criterion based on the International Sepsis Consensus Conference (2003 and 2016 respectively)
  • Patients distributed into 6 groups:

  • Groups 2 and Groups 3 consisted of different patients and have different characteristics
  • In-hospital mortality was 4 times greater in Group 4 compared to Group 5
  • 96 patients (16%) of patients did not have a Sepsis-3 SOFA score available
  • There were no deaths in hospitalized patients in Group 6
Conclusions
  • Sepsis-2 and Sepsis-3 definitions remain arbitrary
  • Sepsis patient evaluation should be based on assessment of vital signs, immune response, clinical picture and response to interventions.
  • The “One Size Fits All” approach has reached its limits

Contact me to learn more about Sepsis assessment and definitions.

Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.