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