How many general and inflammatory variables need to be fulfilled when defining sepsis due to the 2003 SCCM/ESICM/ACCP/ATS/SIS definitions in critically ill surgical patients: a retrospective observational study

• Published in: BMC anesthesiology Vol. 10; no. 1; p. 22
• Main Authors: Weiss, Manfred, Huber-Lang, Markus, Taenzer, Michael, Kron, Martina, Hay, Birgit, Nass, Maximilian, Huber, Moritz, Schneider, Marion
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21-12-2010; BioMed Central; BMC
• Subjects: Anesthesiology; Blood; Care and treatment; Colleges & universities; Comparative analysis; Confidence intervals; Control; Critically ill; Data collection; Diagnosis; Evaluation; Medicine; Mortality; Practice guidelines (Medicine); Sepsis; Septic shock; Standard deviation; United States
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/1471-2253-10-22

It has never been specified how many of the extended general and inflammatory variables of the 2003 SCCM/ESICM/ACCP/ATS/SIS consensus sepsis definitions are mandatory to define sepsis.
To find out how many of these variables are needed to identify almost all patients with septic shock.
Retrospective observational single-centre study in postoperative/posttraumatic patients admitted to an University adult ICU. The survey looked at 1355 admissions, from 01/2007 to 12/2008, that were monitored daily computer-assisted for the eight general and inflammatory variables temperature, heart rate, respiratory rate, significant edema, positive fluid balance, hyperglycemia, white blood cell count and C-reactive protein. A total of 507 patients with infections were classified based on the first day with the highest diagnostic category of sepsis during their stay using a cut-off of 1/8 variables compared with the corresponding classification based on a cut-off of 2, 3, 4, 5, 6, 7 or 8/8 variables.
Applying cut-offs of 1/8 up to 8/8 variables resulted in a decreased detection rate of cases with septic shock, i.e., from 106, 105, 103, 93, 65, 21, 3 to 0. The mortality rate increased up to a cut-off of 6/8 variables, i.e., 31% (33/106), 31% (33/105), 31% (32/103), 32% (30/93), 38% (25/65), 43% (9/21), 33% (1/3) and 0% (0/0).
Frequencies and mortality rates of diagnostic categories of sepsis differ depending on the cut-off for general and inflammatory variables. A cut-off of 3/8 variables is needed to identify almost all patients with septic shock who may benefit from optimal treatment.