Comparison of the Performance Between Sepsis-1 and Sepsis-3 in ICUs in China

Abstract

The definition of sepsis was updated to sepsis-3 in February 2016. However, the performance of the previous and new definition of sepsis remains unclear in China. This was a retrospective multicenter study in six intensive care unit (ICUs) from five university-affiliated hospitals to compare the performance between sepsis-1 and sepsis-3 in China. From May 1, 2016 to June 1, 2016, 496 patients were enrolled consecutively. Data were extracted from the electronic clinical records. We evaluated the performance of sepsis-1 and sepsis-3 by measuring the area under the receiver operating characteristic curves (AUROC) to predict 28-day mortality rates. Of 496 enrolled patients, 186 (37.5%) were diagnosed with sepsis according to sepsis-1, while 175 (35.3%) fulfilled the criteria of sepsis-3. The AUROC of systemic inflammatory response syndrome (SIRS) is significantly smaller than that of sequential organ failure assessment (SOFA) (0.55 [95% confidence interval, 0.46–0.64] vs. 0.69 (95% confidence interval, 0.61–0.77], P = 0.008) to predict 28-day mortality rates of infected patients. Moreover, 5.9% infected patients (11 patients) were diagnosed as sepsis according to sepsis-1 but not to sepsis-3. The APACHE II, SOFA scores, and mortality rate of the 11 patients were significantly lower than of patients whose sepsis was defined by both the previous and new criteria (8.6±3.5 vs. 16.3±6.2, P = < 0.001; 1 (0–1) vs. 6 (4–8), P = <0.001; 0.0 vs. 33.1%, P = 0.019). In addition, the APACHE II, length of stay in ICU, and 28-day mortality rate of septic patients rose gradually corresponding with the raise in SOFA score (but not the SIRS score). Sepsis-3 performed better than sepsis-1 in the study samples in ICUs in China.

External validity of Adult Sepsis Event’s simplified eSOFA criteria: a retrospective analysis of patients with confirmed infection in China

“…Older age (median age 82 for eSOFA+ patients, and 81 for Sepsis-3+ patients in our study) and higher rate of pneumonia might cause the difference since they were proved as independent risk factors for mortality of sepsis patients [4,5,19,20]. Meanwhile, mortality rates of septic patients vary in previous studies by factors including age, sex, comorbidities, and acuity of illness [2,[19][20][21][22]. Third, our cohort represented a patient population significantly different from the original patient population from which eSOFA criteria were developed, as suggested by older age, more pneumonia, higher rate of mechanical ventilation, and higher mortality.…”

Recent Advances in the Molecular Mechanisms Underlying Pyroptosis in Sepsis

“…The morbidity of sepsis also shows seasonal fluctuations, especially reaching the peak in cold winter. Epidemiological studies demonstrated that the mortality of sepsis reached up to 20.6%, implying that the standardized mortality rate was 79/100,000 every year [ 8 , 9 ].…”

Comparison of the predictive value of scoring systems on the prognosis of cirrhotic patients with suspected infection

“…[ 5 ] Thereafter, systemic inflammatory response syndrome (SIRS), SOFA and qSOFA were validated for sepsis patients in intensive care unit (ICU) and emergency department in different countries. [ 6 – 8 ]…”