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Shifting Goal Posts in Sepsis Shoot Carefully

Basiglini L

Sepsis is a leading cause of mortality and critical illness worldwide. In recognising the significant disease burden, the World Health Assembly, the World Health Organisation’s decision-making body, adopted a resolution on improving the diagnosis, management and prevention of sepsis in May 2017. To improve the diagnosis and classification of sepsis, a task force convened by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine published new definitions for sepsis and septic shock (Sepsis-3). Based on the new definitions, sepsis is now defined as evidence of infection plus life-threatening organ dysfunction, clinically characterized by an acute change of two points or greater in the Sequential (Sepsis-related) Organ Failure Assessment score (SOFA). Septic shock refers to sepsis with hypotension unresponsive to fluid resuscitation, serum lactate level greater than 2 L, and the need for vasopressors to maintain mean arterial pressure of 65 mmHg or greater. In contrast, the older Sepsis-2 definitions employed the use of the systemic inflammatory response syndrome (SIRS) criteria, which include elements such as tachycardia, tachypnoea, hyperthermia or hypothermia, and abnormal peripheral white cell counts; sepsis was defined as SIRS associated with an infection, severe sepsis defined as sepsis complicated by organ dysfunction (including acute lung injury, acute oliguria or renal dysfunction, coagulopathy, ileus, hyperbilirubinaemia), and septic shock defined as severe sepsis with persistent hypotension and/or lactate level greater than 4 mmol despite adequate fluid resuscitation. Significantly, the new Sepsis-3 definitions have eliminated the use of the SIRS criteria, as well as abandoned the term “severe sepsis”, incorporating the component of organ dysfunction under “sepsis” and according the latter greater emphasis and clinical importance.