Abstract
BackgroundBaseline characteristics and disease severity of patients with septic shock according to the new Sepsis-3 definition may differ from patients that only comply with the Sepsis-2 definition. We conducted a retrospective cohort study on the ICU of a Belgian tertiary care facility to seek out differences between these two patient groups and to identify variables associated with no longer satisfying the latest definition of septic shock.ResultsOf 1198 patients with septic shock according to the Sepsis-2 consensus definition, 233 (19.4%) did not have septic shock according to the Sepsis-3 shock definition. These patients more often had medical admission reasons and a respiratory infection as cause for the septic shock. They less often had surgery on admission and were less likely to have chronic liver disease (5.6% vs 16.2%, absolute difference 10.6% (95% CI 6.4–14.1%). Patients with septic shock only according to the old definition had significant lower APACHE II and SOFA scores and lower hospital mortality (31.6% vs 55.3%, p < 0.001). In a multivariate analysis, following variables were associated with Sepsis-2 shock patients no longer being defined as such by the Sepsis-3 definition: respiratory infection (OR 1.485 (95% CI 1.56–2.089), p = 0.023), a medical admission reason (OR 1.977 (95% CI 1.396–2.800) and chronic liver disease (OR 0.345 (95% CI 0.181–0.660), p < 0.001).ConclusionsOne in five patients with septic shock according to the Sepsis-2 consensus definition is no longer considered as such when the Sepsis-3 shock criteria are applied. A medical admission reason, a respiratory infection and absence of chronic liver disease are independently associated with no longer being identified as having septic shock by the Sepsis-3 criteria.
Highlights
Baseline characteristics and disease severity of patients with septic shock according to the new Sepsis-3 definition may differ from patients that only comply with the Sepsis-2 definition
The use of Sequential Organ Failure Assessment (SOFA) or quick SOFA results in a more accurate prediction of risk of mortality compared to the old definitions [5, 6]
After exclusion of recurrent episodes of septic shock and of patients missing lactate levels or details on vasopressor therapy, 1198 patients were identified with septic shock according to the Sepsis-2 definition
Summary
Baseline characteristics and disease severity of patients with septic shock according to the new Sepsis-3 definition may differ from patients that only comply with the Sepsis-2 definition. A certain number of patients being classified as having sepsis or septic shock according to this old definition will no longer be held as such by the new one [7]. This could result in a subgroup of septic patients no longer receiving the official label “septic shock” and being excluded from clinical trials or epidemiological studies with all consequences thereof. Our primary goal was to investigate baseline characteristics of septic shock patients who meet the old Sepsis-2 consensus definition but are no longer considered as such by the new Sepsis-3 septic shock definition—with lactate values below 2 mmol/l—and to describe differences in severity of illness. We wanted to identify the factors that are associated with this exclusion
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