Sepsis – 2 (2001)
For the Sepsis – 2 definition the diagnostic criteria from Sepsis – 1 were kept intact.
Severe sepsis was defined as “sepsis complicated by organ dysfunction”. This led to confusion toward the definition of sepsis and severe sepsis. With ten years of additional published data, signs and symptoms of sepsis were greater in number and detail.
These parameters were defined in order to help define the response of the patient with infection. Five areas were listed and defined as: General; Inflammatory; Hemodynamic; Organ Dysfunction; Tissue Perfusion (Table 2).
The original consensus conference defined sepsis as a continuum of ongoing processes from sepsis to severe sepsis to septic shock.
Concerns related to Sepsis – 2 definition
- Diagnostic criteria from Sepsis – 1 was kept in use
- Increased confusion with overlapping definitions between sepsis and severe sepsis
- Increased number of parameters difficult to use
Sepsis – 3 (2016)
New definitions were deemed necessary due to:
- low sensitivity and specificity of SIRS;
- to place greater emphasis on organ dysfunction; and
- advances in sepsis epidemiology and management.
Sepsis – 3 defined sepsis as a “life-threatening organ dysfunction caused by a dysregulated host response to infection”.
Sepsis – 3 defines organ dysfunction as an increase of 2 or more in the Sequential Organ Failure Assessment (SOFA) score. SOFA score should be determined on admission and every 24 hours. In addition, a non-ICU bedside quick SOFA (qSOFA) score was developed for early identification of organ dysfunction of sepsis in these patients (Table 2).
Concerns related to Sepsis – 3 definition
- qSOFA is not a diagnostic criteria nor is it part of the Sepsis – 3 definition.
- The variation and trend in SOFA scores over time may be more important than a one time value
- SOFA score is outdated and needs to be updated
- The new definition does not allow for specific treatment based on the patient’s specific underlying cause of sepsis.
- Although the definition of sepsis has changed over the last 3 decades, there is still no gold standard definition.
- The lack of a standard definition will most likely continue until the definition moves from the current syndrome based terms to a biomarker based definition.
- Although easy to remember and use, SIRS has poor sensitivity and specificity
- Organ dysfunction may be due to causes other than sepsis. When infection is not certain with the presence of organ dysfunction, it is difficult to exclude the diagnosis of sepsis. This may delay early diagnosis and therefore therapy which is key to sepsis management.
Next week’s article will compare and contrast the evolution of the Sepsis Bundles (Resuscitation & Management) from 2004 to the current 2018.