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Sepsis and Septic shock
This document discusses the potential need for an updated definition of sepsis (Sepsis-4) by reviewing the current Sepsis-3 definition. It summarizes various studies and opinions that have questioned aspects of Sepsis-3, such as the validation of the quick Sequential Organ Failure Assessment (qSOFA) score and the lack of evidence that it predicts outcomes better than other scoring tools. The document concludes that Sepsis-3 definitions may be falling out of practice favor and that developing Sepsis-4 will require significant work from medical societies to create practical global definitions of sepsis that incorporate perspectives from low- and middle-income countries.
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Sepsis and Septic shock
- 1. Sepsis and SepticShock; Are We Ready for “Sepsis-4”? Akram M Fayed, MD, ABIM Professor, Department of Critical Care Medicine, Faculty of Medicine University of Alexandria, Egypt 1/18/2017 1
- 2. 1/18/2017 2 Objectives Review ofSepsis- 3 “Singer et. al” Overview of different authors’ Opinions (Editorials) Highlights on Singer’s Editorial in November 2016 Conclusion
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- 11. 1/18/2017 11 AJRCCM Articlesin Press. Published on 20-September-2016
- 12. 1/18/2017 12 Methods: Alladmitted patients first meeting criteria for suspicion of infection in the ED or hospital wards from November 2008 until January 2016 were included The qSOFA, (SIRS), Modified Early Warning Score (MEWS), and the National Early Warning Score (NEWS) were compared for predicting death and ICU transfer 30,677 patients
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- 21. 1/18/2017 21 Conclusions Churpek etal. 2016 is the first study to attempt validation of qSOFA qSOFA and SIRS have similar overall performance in predicting the combined outcome of death or ICU transfer qSOFA has a higher specificity, but this comes as a tradeoff for lower sensitivity
- 22. 1/18/2017 22 Conclusions qSOFA is<40% sensitive for detecting a patient who will die or need ICU transfer in 12 hours qSOFA is consistently out-performed by the NEWS score, a more sophisticated bedside risk-stratification tool This study doesn’t support the Sepsis-3 definition Further evidence is needed before considering the widespread adoption of qSOFA and Sepsis-3 The British approach using the NEWS score appears superior
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- 24. 1/18/2017 24 Published online:3 November 2016
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- 27. 1/18/2017 27 Recommendations Compare theold versus the new definitions using RCTs and epidemiological studies of sepsis and septic shock. The evaluation could demonstrate whether there is a need for the old definition of sepsis and whether SBP or MAP should be used Evaluate the role of single or multiple biomarkers or genetic, epigenetic, inflammatory or anti-inflammatory factors to enhance the definition and/or provide important surrogate end-points to guide management decisions
- 28. 1/18/2017 28 Conclusions Refine theSOFA score to define worsening organ dysfunction taking into account change from preexisting organ dysfunction secondary to sepsis Incorporate clinical parameters to define organ dysfunction for LMICs and thus expand the utility of the score globally Determine diagnostic methodologies to differentiate infected from non-infected patients
- 29. Published online: 3November 2016
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- 37. Conclusions Sepsis-3 definitionsare falling out of favor in terms of real practice Critical Care Medicine Older versions of sepsis definitions might be simpler and self- explanatory compared to Sepsis- 3 definitions keeping the continuum of the sepsis spectrum Sepsis- 4 is mostly on its way but it requires much work from the societies (may be with incorporation of LMICs representatives) to translate the definitions of sepsis into practical ones that could be applied all over the globe 1/18/2017 37
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