The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Singer, Mervyn; Deutschman, Clifford S.; Seymour, Christopher W.; Shankar-Hari, Manu; Annane, Djillali; Bauer, Michael; Bellomo, Rinaldo; Bernard, Gordon R.; Chiche, Jean‐Daniel; Coopersmith, Craig M.; Hotchkiss, Richard S.; Levy, Mitchell M.; Marshall, John C.; Martin, Greg S.; Opal, Steven M.; Rubenfeld, Gordon D.; Poll, Tom van der; Vincent, Jean‐Louis; Angus, Derek C.

doi:10.1001/jama.2016.0287

Cited by 17,787 publications

(16,870 citation statements)

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“…This reflects the third international consensus definition that sepsis is “life-threatening organ dysfunction caused by a dysregulated host response to infection”20 or what the previous sepsis definition conceptualized as “severe sepsis.”14 We did not require explicit sepsis codes because they were not introduced until 2002, after the start of our study.…”

Section: Methodsmentioning

confidence: 86%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

246

202

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Objectives To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.Deign Observational cohort study.Setting US Health and Retirement Study.Participants 960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.Main outcome measures Late (31 days to two years) mortality and odds of death at various intervals.Results Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.Conclusions More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

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Section: Methodsmentioning

confidence: 86%

Late mortality after sepsis: propensity matched cohort study

Prescott

Osterholzer

Langa

et al. 2016

BMJ

246

202

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“…Though the hs‐TnT assay has demonstrated greater sensitivity and negative predictive value in AMI, there are limited data comparing these 2 assays in the septic population 37. The development of the sepsis‐3 criteria could influence the interpretation of the results of this study 38. However, this cohort of severe sepsis and septic shock are less likely to be missed with either definition because they comprise the extreme spectrum of illness 39.…”

Section: Discussionmentioning

confidence: 94%

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

Vallabhajosyula

Sakhuja

Geske

et al. 2017

JAHA

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BackgroundTroponin‐T elevation is seen commonly in sepsis and septic shock patients admitted to the intensive care unit. We sought to evaluate the role of admission and serial troponin‐T testing in the prognostication of these patients.Methods and ResultsThis was a retrospective cohort study from 2007 to 2014 on patients admitted to the intensive care units at the Mayo Clinic with severe sepsis and septic shock. Elevated admission troponin‐T and significant delta troponin‐T were defined as ≥0.01 ng/mL and ≥0.03 ng/mL in 3 hours, respectively. The primary outcome was in‐hospital mortality. Secondary outcomes included 1‐year mortality and lengths of stay. During this 8‐year period, 944 patients met the inclusion criteria with 845 (90%) having an admission troponin‐T ≥0.01 ng/mL. Serial troponin‐T values were available in 732 (78%) patients. Elevated admission troponin‐T was associated with older age, higher baseline comorbidity, and severity of illness, whereas significant delta troponin‐T was associated with higher severity of illness. Admission log10 troponin‐T was associated with unadjusted in‐hospital (odds ratio 1.6; P=0.003) and 1‐year mortality (odds ratio 1.3; P=0.04), but did not correlate with length of stay. Elevated delta troponin‐T and log10 delta troponin‐T were not significantly associated with any of the primary or secondary outcomes. Admission log10 troponin‐T remained an independent predictor of in‐hospital mortality (odds ratio 1.4; P=0.04) and 1‐year survival (hazard ratio 1.3; P=0.008).ConclusionsIn patients with sepsis and septic shock, elevated admission troponin‐T was associated with higher short‐ and long‐term mortality. Routine serial troponin‐T testing did not add incremental prognostic value in these patients.

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“…According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis‐3),5, 6, 7 sepsis is defined as “life‐threatening organ dysfunction caused by a dysregulated host response to infection.” The clinical criteria of sepsis are suspected or documented infection and an acute increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more. Septic shock is defined as a subset of sepsis in which the underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.…”

Section: Introductionmentioning

confidence: 99%

“…In out‐of‐hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute the quick SOFA (qSOFA): a respiratory rate of 22 breaths/min or higher, altered consciousness, and a systolic blood pressure of 100 mmHg or less 5, 6, 7. The qSOFA criteria can be used to prompt clinicians to further investigate for organ dysfunction, to initiate or escalate therapy as appropriate, and to consider referral for critical care.…”

Section: Introductionmentioning

confidence: 99%

“…As such, currently, the description of “infection‐induced systemic inflammatory response syndrome (SIRS)” based on the criteria and definition proposed by Goldstein et al . in 2005455 is designated as sepsis (“‘old’ sepsis”), and the conception of severe sepsis as “infection accompanied by organ dysfunction” is designated as “‘old’ severe sepsis”, and “sepsis” has been newly defined to include “infection accompanied by organ dysfunction” as well, in line with the Sepsis‐35 definition.…”

Section: Introductionmentioning

confidence: 99%

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Cited by 17,787 publications

References 37 publications

Late mortality after sepsis: propensity matched cohort study

Late mortality after sepsis: propensity matched cohort study

Role of Admission Troponin‐T and Serial Troponin‐T Testing in Predicting Outcomes in Severe Sepsis and Septic Shock

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

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