The Impact of the Sepsis-3 Septic Shock Definition on Previously Defined Septic Shock Patients

• Published in: Critical care medicine Vol. 45; no. 9; pp. 1436 - 1442
• Main Authors: Sterling, Sarah A., Puskarich, Michael A., Glass, Andrew F., Guirgis, Faheem, Jones, Alan E.
• Format: Journal Article
• Language: English
• Published: United States by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc 01-09-2017; Copyright by by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc
• Subjects: Blood Pressure; Clinical Trials as Topic; Emergency Service, Hospital - statistics & numerical data; Hospital Mortality; Humans; Lactic Acid - blood; Organ Dysfunction Scores; Severity of Illness Index; Shock, Septic - diagnosis; Shock, Septic - mortality; Shock, Septic - physiopathology; Shock, Septic - therapy; Systemic Inflammatory Response Syndrome - diagnosis; Systemic Inflammatory Response Syndrome - physiopathology; United States; Vasoconstrictor Agents - administration & dosage
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/CCM.0000000000002512

OBJECTIVE:The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the “old” (1991) criteria of septic shock only.
DESIGN:Secondary analysis of two clinical trials of early septic shock resuscitation.
SETTING:Large academic emergency departments in the United States.
PATIENTS:Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90 mm Hg after fluid resuscitation.
INTERVENTIONS:Patients were further categorized as Sepsis-3 septic shock if they demonstrated hypotension, received vasopressors, and exhibited a lactate greater than 2 mmol/L. We compared in-hospital mortality in patients who met the old definition only with those who met the Sepsis-3 criteria.
MEASUREMENTS AND MAIN RESULTS:Four hundred seventy patients were included in the present analysis. Two hundred (42.5%) met Sepsis-3 criteria, whereas 270 (57.4%) met only the old definition. Patients meeting Sepsis-3 criteria demonstrated higher severity of illness by Sequential Organ Failure Assessment score (9 vs 5; p < 0.001) and mortality (29% vs 14%; p < 0.001). Subgroup analysis of 127 patients meeting only the old definition demonstrated significant mortality benefit following implementation of a quantitative resuscitation protocol (35% vs 10%; p = 0.006).
CONCLUSION:In this analysis, 57% of patients meeting old definition for septic shock did not meet Sepsis-3 criteria. Although Sepsis-3 criteria identified a group of patients with increased organ failure and higher mortality, those patients who met the old criteria and not Sepsis-3 criteria still demonstrated significant organ failure and 14% mortality rate.