Defining sepsis on the wards: results of a multi‐centre point‐prevalence study comparing two sepsis definitions

Abstract

Our aim was to prospectively determine the predictive capabilities of SEPSIS-1 and SEPSIS-3 definitions in the emergency departments and general wards. Patients with National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled over a 24-h period in 13 Welsh hospitals. The primary outcome measure was mortality within 30 days. Out of the 5422 patients screened, 431 fulfilled inclusion criteria and 380 (88%) were recruited. Using the SEPSIS-1 definition, 212 patients had sepsis. When using the SEPSIS-3 definitions with Sequential Organ Failure Assessment (SOFA) score ≥ 2, there were 272 septic patients, whereas with quickSOFA score ≥ 2, 50 patients were identified. For the prediction of primary outcome, SEPSIS-1 criteria had a sensitivity (95%CI) of 65% (54-75%) and specificity of 47% (41-53%); SEPSIS-3 criteria had a sensitivity of 86% (76-92%) and specificity of 32% (27-38%). SEPSIS-3 and SEPSIS-1 definitions were associated with a hazard ratio (95%CI) 2.7 (1.5-5.6) and 1.6 (1.3-2.5), respectively. Scoring system discrimination evaluated by receiver operating characteristic curves was highest for Sequential Organ Failure Assessment score (0.69 (95%CI 0.63-0.76)), followed by NEWS (0.58 (0.51-0.66)) (p < 0.001). Systemic inflammatory response syndrome criteria (0.55 (0.49-0.61)) and quickSOFA score (0.56 (0.49-0.64)) could not predict outcome. The SEPSIS-3 definition identified patients with the highest risk. Sequential Organ Failure Assessment score and NEWS were better predictors of poor outcome. The Sequential Organ Failure Assessment score appeared to be the best tool for identifying patients with high risk of death and sepsis-induced organ dysfunction.

Improving outcome of sepsis on the ward: introducing the ‘Sepsis Six’ bundle

“…The acuity of the cohort was high as NEWS 7 or higher indicates the need for prompt assessment by a clinical team with critical care competencies and consideration for transfer of the patient to a higher‐dependency care area (McGinley and Pearse, ). Similar NEWS scores were observed in recent US and UK studies, including ours (Churpek et al, ; Corfield et al, ; Szakmany et al, ; Szakmany et al, ). Importantly, 91% of the patients appeared to respond favourably to the Sepsis Six, and only six patients had an increase in their NEWS within 24 h of treatment.…”

“…Baseline data on compliance with the Sepsis Six was 34% for all patients who were admitted to the ICU with sepsis in 2011 (local audit). Data from our collaborative studies from every Welsh hospital confirmed that this is not an isolated problem: we found that only 24 of 290 patients who fulfilled the sepsis criteria were seen by the CCOT in 2015, and this did not improve in 2016 (Szakmany et al, , ). Based on these figures, we estimate that, at the beginning of our observation period, there were at least thrice as many patients with sepsis on the wards compared with the ones seen by the CCOT.…”

“…Unfortunately, there were no reliable estimates of the number of patients with sepsis on the general wards at the start of the study. To date, the only point‐prevalence data available in the UK from the general wards is from our group, suggesting that sepsis prevalence is between 3·6% and 4·2% depending on the definition and clinical tool used (Szakmany et al, , , ). In these studies, only one in five patients with sepsis were seen by the CCOT, raising the possibility of selection bias in our study.…”

Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

“…In this meta-analysis, 35 studies with 269,544 patients reported on the prognostic accuracy of the qSOFA and short-term mortality, including 27 retrospective studies [5][6][7][8]10,11,[13][14][15][16]18,20,22,[24][25][26][27]29,[32][33][34][35][37][38][39][40] , while 8 studies were prospective studies 9,12,17,19,21,23,28,30,36 . Due to the heterogeneity of the inclusion criteria, a random-effects model was used to calculate the pooled sensitivity and specificity of the included studies.…”

Development of a Bioinformatics Framework for Identification and Validation of Genomic Biomarkers and Key Immunopathology Processes and Controllers in Infectious and Non-infectious Severe Inflammatory Response Syndrome

“…Sepsis is described as "life-threatening organ dysfunction caused by a dysregulated host response to infection, " leading to injury to healthy tissues, including those remote to the infection site (1,2) and is part of a systemic inflammatory response syndrome group of conditions which can be infectious or non-infectious in origin. This can then progress to organ failure (such as acute kidney and acute lung injury) and septic shock if there is additional cardiovascular system involvement (3).…”