Sepsis and Septic Shock Redefined

The statistics are shocking:

  • More than 1.5 million people in the U.S. get sepsis annually.
  • About 250,000 Americans die from sepsis each year.
  • One in three patients who die in a hospital has sepsis.

A CDC evaluation found seven in 10 patients with sepsis had recently used healthcare services or had chronic diseases requiring frequent medical care.

What, Exactly, Is Sepsis? Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs. Pathogens that can cause infections that can develop into sepsis include staph, E. coli, and some types of strep. Patients who survive sepsis can have long-term physical, psychological, and cognitive disabilities, with significant health-care and social implications.

Some Previous Diagnostic Criteria Eliminated. Last year, an international task force redefined what sepsis is, in order to differentiate it from uncomplicated infection. The 19-member task force eliminated previous criteria for diagnosis, such as inflammation, which they say led to missed diagnosis and overdiagnosis.

The new definitions eliminate using two or more Systemic Inflammatory Response Syndromes (SIRS) criteria for diagnosis. Other SIRS criteria include tachycardia (a heart rate that exceeds the normal resting heart rate, such as 100 beats per minute), tachypnea (abnormally rapid breathing), hyperthermia (body temperature greatly above normal) or hypothermia (body heat loss/dangerously low body temperature), and elevated blood count (blood cells reacting to infection in the body). The task force explained the SIRS criteria are too broad and are present in many hospitalized patients who never develop infection or have bad outcomes.

New Criteria Set. The new definition for sepsis includes evidence for infection, and life-threatening organ dysfunction. Septic shock is more severe and carries greater risk of mortality. It is defined to include: sepsis with fluid-unresponsive hypotension, serum lactate level greater than 2 mmol/L (a marker for cellular hypoxia), and a need for vasopressors (blood vessel-constricting drugs) to maintain mean arterial pressure of 65 mm Hg or greater.

Task Force Process. One of the task force members, Christopher W. Seymour MD, of the University of Pittsburgh School of Medicine, and colleagues used a base of 148,907 patients with suspected sepsis infections. Using this group, they identified a method of identifying sepsis outside of a hospital setting that includes two or more criteria: a respiratory rate of 22/min or greater (normal rate is 12/min), altered mentation (disorders of mental functioning), or systolic (top number) blood pressure of 100 mmHg or less. They found that 25 percent of patients with two or more positive symptoms accounted for 70 percent of sepsis patients.

Septic Shock. The task force recommended that septic shock be known as a “subset of sepsis…associated with a greater risk of mortality than sepsis alone.” It recommended also that adult patients with septic shock can be identified using the clinical criteria of hypotension requiring vasopressor therapy to maintain a mean blood pressure of 65 mm Hg or greater, and having a serum lactate level greater than 2 mmol/L after adequate fluid resuscitation.

The study was published in the Journal of the American Medical Association in 2016, concurrent with the meeting of the Third International Consensus Definitions for Sepsis and Septic Shock. The definitions were endorsed by more than three dozen medical organizations worldwide.

What This Means For You. It is important for the public to be aware of the danger and extent of sepsis, and the risks and infections associated with sepsis and septic shock. Prevention includes preventing and managing infections, managing chronic conditions, keeping scrapes and wounds clean, recognizing early signs of worsening infection, and immediately seeking medical care.

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