Sepsis-3 definitions predict ICU mortality in a low–middle-income country

Besen, Bruno Adler Maccagnan Pinheiro; Romano, Thiago Gomes; Nassar, Antônio Paulo; Taniguchi, Leandro Utino; Azevedo, Luciano César Pontes; Mendes, Pedro Vitale; Zampieri, Fernando Godinho; Park, Marcelo

doi:10.1186/s13613-016-0204-y

Cited by 48 publications

(39 citation statements)

References 28 publications

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“…Our findings could support the use of SOFA scores even in a resource‐limited ward setting, although it is unclear how this might best be integrated into already established track and trigger systems . Donnelly et al were able to show in a population‐based study that high admission SOFA was the best tool predict poor outcome in the hospital and within one year after discharge, with similar AUROC (0.765) and HR 2.43 (95%CI 1.84–3.21) to ours .…”

Section: Discussionsupporting

confidence: 81%

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

et al. 2017

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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.

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Section: Discussionsupporting

confidence: 81%

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

et al. 2017

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“…A number of prior studies have evaluated methods for identifying high risk infection patients in various settings. 4, 6, 26–31 Iwashyna, et al examined the validity of claims-based algorithms for identifying sepsis relative to events defined clinically based on prior international consensus criteria, finding high specificity and positive predictive values with modest sensitivity. 26 Gaieski, et al examined several methods for identifying sepsis in administrative data and found striking differences the total burden of sepsis and temporal trends in incidence depending on the algorithm.…”

Section: Discussionmentioning

confidence: 99%

Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study

Donnelly

Safford

Shapiro

et al. 2017

The Lancet Infectious Diseases

113

107

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BACKGROUND The Third International Consensus Definitions for Sepsis (Sepsis-3) present clinical criteria for classifying infection patients. Event incidence and long-term outcomes across these classifications are unknown. METHODS We conducted a retrospective analysis using data from 30,239 US participants aged ≥45 years enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified hospitalizations over 2003–2012 using three classifications: infection with systemic inflammatory response syndrome (SIRS), elevated sepsis-related organ failure assessment score (SOFA), or elevated “quick” SOFA (qSOFA) score. We examined incidence over the study period, in-hospital mortality, and one-year mortality, providing estimates and 95% confidence intervals (CIs). FINDINGS Among 2,593 infection events, there were 1,526 sepsis-SIRS, 1,080 sepsis-SOFA, and 378 sepsis-qSOFA events. Sepsis-SIRS events had the highest incidence (8.2 per 1,000 person-years; 95% CI 7.8–8.7), followed by sepsis-SOFA (5.8; CI 5.4–6.1) and sepsis-qSOFA (2.0; CI 1.8–2.2). In-hospital mortality was higher for sepsis-qSOFA (67/295; 22.7%) than sepsis-SOFA (125/960; 13.0%) and sepsis-SIRS (128/1,392; 9.2%). One-year mortality post-discharge was also highest for sepsis-qSOFA (29.4 per 100 person-years; CI 22.3–38.7) compared to sepsis-SOFA (22.6; CI 19.2–26.6) and sepsis-SIRS (14.7; CI 12.5–17.2). INTERPRETATION The examined classifications identified different incidence and mortality. Our findings support the use of the sepsis-SOFA and sepsis-qSOFA classifications for identification of infection patients at elevated risk of poor outcomes. We also demonstrate how these classifications could be used in future epidemiological assessments and studies of patients with infection. FUNDING National Institute for Nursing Research (R01-NR012726), National Center for Research Resources (UL1-RR025777), and National Institute of Neurological Disorders and Stroke (U01-NS041588). JPD held an Agency for Healthcare Research and Quality predoctoral fellowship (T32-HS013852). MMS was supported by a mentoring award from the National Heart, Lung and Blood Institute (K24-HL111154).

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“…Subsequent studies appear to validate the criteria in both low-middle and developing countries [109][110][111], although this is relatively limited in scope. There are also two large prospective evaluations of the predictive model in the literature from the United States and Australia [112,113].…”

Section: How Can We Screen For Sepsis In Varied Settings?mentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Sepsis-3 definitions predict ICU mortality in a low–middle-income country

Cited by 48 publications

References 28 publications

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

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

Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study

Surviving sepsis campaign: research priorities for sepsis and septic shock

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