Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients: A Cohort Study in 49 ICUs in Argentina

Bakker, Jan; Edul, Vanina Siham Kanoore; Loudet, Cecilia; Osatnik, Javier; Ríos, Fernando; Vázquez, Daniela N; Pozo, Mario Omar; Lattanzio, Bernardo; Pálizas, Fernando; Klein, Francisco; Piezny, Damián; Birri, Paolo Nahuel Rubatto; Tuhay, Graciela; Díaz, Anatilde; Santamaría, Analía; Zakalik, Graciela; Dubin, Arnaldo; Investigators, Satisepsis

doi:10.1097/ccm.0000000000003208

Cited by 23 publications

(25 citation statements)

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“…Briefly, SATISEPSIS was a national, multicenter, prospective cohort study organized by the SATI and sponsored by the Argentine National Ministry of Health, beginning on July 2, 2016 and lasting for 3 months [14,15]. The study was approved by each hospital's Institutional Review Board, and informed consent was signed by patients or their relatives.…”

Section: Designmentioning

confidence: 99%

“…SATISEPSIS was an observational study organized by the Argentine Society of Critical Care (Sociedad Argentina de Terapia Intensiva, SATI) to evaluate the performance of the new Sepsis-3 definitions [13], and to characterize the epidemiology and outcome of sepsis and septic shock in Argentina, a country belonging to the group of low and middle-income countries (LMICs) [14,15]. The aim of the present study was to assess the characteristics of the cardiovascular management, particularly regarding early resuscitation and use of intravenous fluids.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Dubin

Loudet

Edul

et al. 2020

Ann. Intensive Care

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Background: Resuscitation of septic patients regarding goals, monitoring aspects and therapy is highly variable. Our aim was to characterize cardiovascular and fluid management of sepsis in Argentina, a low and middle-income country (LMIC). Furthermore, we sought to test whether the utilization of dynamic tests of fluid responsiveness, as a guide for fluid therapy after initial resuscitation in patients with persistent or recurrent hypoperfusion, was associated with decreased mortality.Methods: Secondary analysis of a national, multicenter prospective cohort study (n = 787) fulfilling Sepsis-3 definitions. Epidemiological characteristics, hemodynamic management data, type of fluids and vasopressors administered, physiological variables denoting hypoperfusion, use of tests of fluid responsiveness, and outcomes, were registered. Independent predictors of mortality were identified with logistic regression analysis.Results: Initially, 584 of 787 patients (74%) had mean arterial pressure (MAP) < 65 mm Hg and/or signs of hypoperfusion and received 30 mL/kg of fluids, mostly normal saline (53%) and Ringer lactate (35%). Vasopressors and/ or inotropes were administered in 514 (65%) patients, mainly norepinephrine (100%) and dobutamine (9%); in 22%, vasopressors were administered before ending the fluid load. After this, 413 patients (53%) presented persisting or recurrent hypotension and/or hypoperfusion, which prompted administration of additional fluid, based on: lactate levels (66%), urine output (62%), heart rate (54%), central venous O 2 saturation (39%), central venous-arterial PCO 2 difference (38%), MAP (31%), dynamic tests of fluid responsiveness (30%), capillary-refill time (28%), mottling (26%), central venous pressure (24%), cardiac index (13%) and/or pulmonary wedge pressure (3%). Independent predictors of mortality were SOFA and Charlson scores, lactate, requirement of mechanical ventilation, and utilization of dynamic tests of fluid responsiveness. © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article' s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article'

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Section: Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Dubin

Loudet

Edul

et al. 2020

Ann. Intensive Care

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“…Since the latest update of the sepsis-definition by consensus, severe infections are stratified as infections without organ dysfunction, sepsis, and septic shock [6], and this is believed to allow a reliable risk stratification of these patients regarding their in-hospital mortality [7]. However, sequelae and long-term outcome may not only relate to acute organ dysfunction, but rather to a "dysregulated", long lasting host immune response that may explain the high mortality with severe infections [4,8].…”

Section: Introductionmentioning

confidence: 99%

Long-term mortality and outcome in hospital survivors of septic shock, sepsis, and severe infections: The importance of aftercare

et al. 2020

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Patients with severe infections and especially sepsis have a high in-hospital mortality, but even hospital survivors face long-term sequelae, decreased health-related quality of life, and high risk of death, suggesting a great need for specialized aftercare. However, data regarding a potential benefit of post-discharge rehabilitation in these patients are scarce. In this retrospective matched cohort study the claim data of a large German statutory health care insurer was analyzed. 83,974 hospital survivors having suffered from septic shock, sepsis, and severe infections within the years 2009-2016 were identified using an ICD abstraction strategy closely matched to the current Sepsis-3 definition. Cases were analyzed and compared with their matched pairs to determine their 5-year mortality and the impact of post-discharge rehabilitation. Five years after hospital discharge, mortality of initial hospital survivors were still increased after septic shock (HR adj 2.03, 95%-CI 1.87 to 2.19; P<0.001), sepsis (HR adj 1.73, 95%-CI 1.71 to 1.76; P<0.001), and also in survivors of severe infections without organ dysfunction (HR adj 1.70, 95%-CI 1.65 to 1.74; P<0.001) compared to matched controls without infectious diseases. Strikingly, patients treated in rehabilitation facilities showed a significantly improved 5-year survival after suffering from sepsis or septic shock (HR adj 0.81, 95%-CI 0.77 to 0.85; P<0.001) as well as severe infections without organ dysfunction (HR adj 0.81, 95%-CI 0.73 to 0.90; P<0.001) compared to matched patients discharged to home or self-care. Long-term mortality and morbidity of hospital survivors are markedly increased after septic shock, sepsis and severe infections without organ dysfunction, but best 5-year survival was recorded in patients discharged to a rehabilitation facility in all three groups. Thus, our data suggest that specialized aftercare programs may help to improve long-term outcome in these patients and warrants more vigilance in future investigations.

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“…In very good agreement with sepsis-3 validation study, we observed moderate discrimination capacity of SOFA applications for in-hospital mortality in infected patients (AUROC for SOFA and SOFA_change respectively: 0.75 and 0.70 in our data while 0.74 and 0.70 in sepsis-3 [9]) that was higher than SIRS' AUROC for in-hospital mortality. Further studies in the ICU setting replicating this evaluation approach also reported comparable results [29,31,32,37]. However, the use of AUROC for the assessment of risk prediction in general [57] and for sepsis-3 validation in particular [17,58] was criticized.…”

Section: Associations Of Sepsis Criteria With In-hospital Mortalitymentioning

confidence: 88%

Impact of different consensus definition criteria on sepsis diagnosis in a cohort of critically ill patients—Insights from a new mathematical probabilistic approach to mortality-based validation of sepsis criteria

et al. 2020

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Background Sepsis-3 definition uses SOFA score to discriminate sepsis from uncomplicated infection, replacing SIRS criteria that were criticized for being inaccurate. Eligibility of sepsis-3 criteria for sepsis diagnosis and the applied validation methodology using mortality as endpoint are topic of ongoing debate. We assessed the impact of different criteria on sepsis diagnosis in our ICU and devised a mathematical approach for mortality-based validation of sepsis criteria. As infectious status is often unclear at clinical deterioration, we integrated non-infected patients into analysis. Methods Suspected infection, SOFA and SIRS were captured for an ICU cohort of a university center over one year. For raw scores (SIRS/SOFA) and sepsis criteria (SIRS�2/SOFA�2/ SOFA_change�2) frequencies and associations with in-hospital mortality were assessed. Using a mathematical approach, we estimated the correlation between sepsis and in-hospital mortality serving as reference for evaluation of observed mortality correlations of sepsis criteria. Results Of 791 patients, 369 (47%) were infected and 422 (53%) non-infected, with an in-hospital mortality of 39% and 15%. SIRS�2 indicated sepsis in 90% of infected patients, SOFA�2 in 99% and SOFA_change�2 in 77%. In non-infected patients, SIRS, SOFA and SOFA_ change were �2 in 78%, 88% and 58%. In AUROC analyses neither SOFA nor SIRS

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Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients: A Cohort Study in 49 ICUs in Argentina

Cited by 23 publications

References 42 publications

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Characteristics of resuscitation, and association between use of dynamic tests of fluid responsiveness and outcomes in septic patients: results of a multicenter prospective cohort study in Argentina

Long-term mortality and outcome in hospital survivors of septic shock, sepsis, and severe infections: The importance of aftercare

Impact of different consensus definition criteria on sepsis diagnosis in a cohort of critically ill patients—Insights from a new mathematical probabilistic approach to mortality-based validation of sepsis criteria

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