The new sepsis consensus definitions: the good, the bad and the ugly

@article{Sprung2016TheNS,
  title={The new sepsis consensus definitions: the good, the bad and the ugly},
  author={C. Sprung and R. Schein and R. Balk},
  journal={Intensive Care Medicine},
  year={2016},
  volume={42},
  pages={2024-2026}
}
Introduction Despite improvements in diagnosis and management, sepsis and septic shock remain frequent causes of morbidity and mortality. Singer and colleagues [1–3] recently updated the consensus definitions of sepsis and septic shock to improve both sensitivity and specificity compared with the previous definitions [4]. We present here our opinions of the potential ramifications of this important work (Table 1). 

Tables and Topics from this paper

The new sepsis consensus definitions (Sepsis-3): the good, the not-so-bad, and the actually-quite-pretty
TLDR
The rise in the number of patients coded for severe sepsis in a nationwide hospital sample in the USA rose from 300,270 to 781,725 within 8 years, with mortality nearly doubling, highlights the failure of current epidemiology to accurately assess the impact of septicaemia. Expand
Back to Basics: Recognition of Sepsis with New Definition
TLDR
The purpose of this article is to introduce the updated definition of sepsis and suggest its practical implications, with particular emphasis on integrative clinical assessment, allowing for the rapid identification of patients who are at risk of further deterioration. Expand
Controversies Regarding the New Definition of Sepsis
The Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) task force assessed the latest pathophy-siological parameters associated with sepsis and septic shock and definedExpand
Changing Definitions of Sepsis.
TLDR
The diagnosis and definition of sepsis is a critical problem due to the heterogeneity of this disease process, and recently updated the consensus definitions improved specificity compared with the previous descriptions. Expand
Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients: A Cohort Study in 49 ICUs in Argentina
TLDR
This study supports the predictive validity of Sepsis-3 definitions and indicates that Sequential Organ Failure Assessment score shows adequate prognosis accuracy─contrary to systemic inflammatory response syndrome. Expand
Update of Sepsis in the Intensive Care Unit
TLDR
Several randomized controlled trials (RCT) that analyzed new (and old) interventions in sepsis/septic shock are discussed in this review in parallel with the SSC 2016 recommendations and other guidelines when relevant. Expand
Rethinking the concept of sepsis and septic shock.
TLDR
This narrative review is to discuss and compare the new criteria of 2016 with the old criteria, purposing at the same time an alternative approach for this topic, allowing the early selection of patients who are infected and require faster treatment, while the search for a better and faster tool continues. Expand
What Is Sepsis
TLDR
It is now recognized that the biological phenotype of sepsis varies markedly, both between patients and over time, and a one-size-fits-all therapeutic approach is increasingly viewed as over-simplistic, explaining the failure of various strategies in multiple randomized controlled trials. Expand
Sepsis-3: Seeing the Entire Picture.
TLDR
It is suggested that Sepsis-3 is best suited for epidemiology and certain research projects and the Sepsis -3 nomenclature be reconciliated with theSepsis-1 terms to avoid confusion. Expand
Prediction of pediatric sepsis mortality within 1 h of intensive care admission
TLDR
The importance of lactate, cardiovascular, and respiratory derangements at ICU admission for the identification of children with substantially higher risk of sepsis mortality is demonstrated, supporting the need for specialized definitions of septic shock severity in children. Expand
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References

SHOWING 1-10 OF 17 REFERENCES
To SIRS With Love-An Open Letter.
TLDR
With the advent of sepsis-3, it is important to consider whether there is still a place for the systemic inflammatory response syndrome (SIRS), and the term “SirS” was coined to recognize the importance of this syndrome. Expand
Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
TLDR
A consensus process using results from a systematic review, surveys, and cohort studies found that adult patients with septic shock can be identified using the clinical criteria of hypotension requiring vasopressor therapy to maintain mean BP 65 mm Hg or greater and having a serum lactate level greater than 2 mmol/L after adequate fluid resuscitation. Expand
The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study)
TLDR
Patients whose care included compliance with all of the evidence-based bundle metrics had a 40 % reduction in the odds of dying in hospital with the 3-h bundle and 36 % for the 6-h bundles. Expand
Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine.
TLDR
Broad definitions of sepsis and the systemic inflammatory response syndrome were proposed, along with detailed physiologic parameters by which a patient may be categorized, and the use of severity scoring methods when dealing with septic patients was recommended as an adjunctive tool to assess mortality. Expand
Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
TLDR
To evaluate the validity of clinical criteria to identify patients with suspected infection who are at risk of sepsis, a new model derived using multivariable logistic regression in a split sample was derived. Expand
The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study.
TLDR
This prospective epidemiologic study of SIRS and related conditions provides the first evidence of a clinical progression from SirS to sepsis to severe sepsi and septic shock, and stepwise increases in mortality rates in the hierarchy. Expand
An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence in Acutely ill Patients (SOAP) study
TLDR
Although common in the ICU, SIRS has prognostic importance in predicting infections, severity of disease, organ failure and outcome and is associated with a higher risk of subsequent development of severe sepsis. Expand
The epidemiology of the systemic inflammatory response
TLDR
While about three of four deaths occur during the first months after sepsis, the septic syndromes significantly impact on long-term outcome, with an estimated 50 % reduction of life expectancy over the following five years. Expand
The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure
TLDR
A so-called sepsis-related organ failure assessment (SOFA) score is created to describe quantitatively and as objectively as possible the degree of organ dysfunction/failure over time in groups of patients or even in individual patients. Expand
Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008
TLDR
The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to guide assessment of quality of evidence from high to very low and to determine the strength of recommendations. Expand
...
1
2
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