Abstract
BackgroundIt 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.ObjectivesTo find out how many of these variables are needed to identify almost all patients with septic shock.MethodsRetrospective 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.ResultsApplying 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).ConclusionsFrequencies 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.
Highlights
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
A total of 1628 postoperative/posttraumatic patients were admitted from 01 Jan 2007 to 31 Dec 2008 in the intensive care unit (ICU) and were surveyed daily using computer-assistance with respect to sepsis, organ dysfunctions assessment and shock based on the 2003 SCCM/ESICM/ACCP/ ATS/SIS sepsis definitions [3]. 1355 patients ≥ 18 years of age with a total of 8955 observations were available
The present study shows that defining sepsis with cutoffs at 1, 2, 3, 4, 5, 6, 7, or 8 out of 8 general and inflammatory variables was markedly associated with frequency and mortality rate of cases with septic shock in critically ill surgical patients
Summary
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. In 2003, the revised Society of Critical Care Medicine/ European Society of Critical Care Medicine/American College of Chest Physicians/American Thoracic Society, Surgical Infection Society (SCCM/ESICM/ACCP/ATS/ SIS) sepsis definitions were published to better reflect the reality at the bedside, especially, to address how physicians diagnose sepsis in daily practice regarding general, inflammatory, hemodynamic, organ dysfunction, and tissue perfusion variables [3]. Clear cut-offs for organ dysfunctions were provided Despite these improvements, the 2003 definitions are scarcely used due to complexity and uncertainty, since the definitions leave unclear how many of the general and inflammatory variables should be used as diagnostic criteria for sepsis
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