Consensus of Chinese experts on early prevention and blocking of sepsis

Abstract

Sepsis is an ongoing conundrum and challenge in medical field. With the rapid development and progress of modern medicine, sepsis has been researched and explored in greater depth across different fields. Although "Surviving Sepsis Campaign" (SSC) has been taken to tackle sepsis in the world for years, its incidence and mortality stay high. According to the updated definition of sepsis stated in the current international guidelines, sepsis is defined as the infection-induced host response disorder, which further results in circulation and/or organ dysfunction. The original source of sepsis is infection, and it is a complicated pathophysiological process from infection to sepsis, which involves the invasion of pathogens, release of cytokines, capillary leakage, and microcirculation dysfunction, thus causing organ metabolism disorder and failure. As shown in Sepsis-3, the sepsis diagnosis standard is stipulated as infection plus sequential organ failure assessment (SOFA) score ≥ 2, and the tackling of sepsis mainly lies on the "life-saving" treatment regarding organ functions. After about 20 years' efforts, SSC has not achieved satisfactory results. As a frontier discipline of acute and critical diseases, emergency medical department is able to receive and cure the patients with acute infection at the earliest. The incidence and mortality of sepsis could be greatly reduced if the possibility of sepsis can be predicted from population characteristics, pathogens and locations of infection, and severity of illness at the early stage of infection. Besides, timely discovering "inflammation storm" by cytokine detection and accessing the patients with an effective clinical scoring system should also be helpful to take more active and effective treatment to the high-risk patients, and block the progression from infection to sepsis. On such a basis, Chinese emergency medicine specialists have put forward the concept of "prevention and blocking" of sepsis, and carried out "Preventing Sepsis Campaign in China" (PSCC) throughout China. They have also proposed the principles of performing targeted diagnosis, examination and treatment at the "early stage of sepsis" and "peri-sepsis period", so as to realize the early prevention, early discovery, and early intervention, and reduce the morbidity and mortality of sepsis, thus providing a new concept for diagnosis and treatment of patients with acute severe infection. This consensus is jointly advocated, discussed and written by four academic societies (associations) and five related publishing houses, and formed after several turns of discussions by more than 40 specialists and experts from emergency medicine, critical medicine, infectious medicine, pharmacy, laboratory medicine, and other professional disciplines. This consensus involves determination and recognition of patients with acute infection, anti-infective therapy, screening of high-risk sepsis patients, discovery of and response to "inflammation storm", protection of vascular endothelial cells and regulation of coagulation function, liquid support scheme and organ function protection strategy, etc. This consensus summarizes the commonly used Western medical diagnosis and treatment measures, and also integrates the advantages of traditional Chinese medicine in prevention and treatment of sepsis, so as to provide a comprehensive reference for the clinicians to perform diagnosis and treatment, and provide a reliable basis for reducing progression of infected patients to sepsis.