Hospitalized patients with suspected infection who experience acute deterioration and who meet the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) septic shock criteria may be at higher risk for in-hospital mortality compared to those who meet the SIRS (Systemic Inflammatory Response Syndrome)-based septic shock criteria, according to results of a recently published study in CHEST.
Early identification and management of hospitalized patients with sepsis and septic shock is an important component for improving survival. Many hospitals have rapid response teams (RRTs) to assess deteriorating patients to determine subsequent management, including Intensive Care Unit (ICU) admission. In patients with suspected sepsis and septic shock, the Sepsis-3 clinical criteria have a potential role in detection, risk stratification, and prognostication, although the accuracy of these criteria in comparison to the SIRS-based septic shock criteria is unknown. Therefore, this study evaluated the prognostic accuracy of the Sepsis-3 criteria vs the SIRs-based criteria in determining mortality among hospitalized patients with infection and acute deterioration.
Participants (n=1708) were included if they were ≥18 years of age, received RRT activation between May 2012 and 2016, and were suspected of having infection prior to or at the time of RRT assessment. Suspected infection was defined as concomitant administration of oral or parenteral antibiotics, as well as body fluid (eg, blood, urine, cerebrospinal fluid, or peritoneal) culture.
Of total participants, 24.5% met Sepsis-3 septic shock criteria and 31.9% met the SIRS-based septic shock criteria. Patients meeting Sepsis-3 septic shock criteria had higher in-hospital mortality (40.9% vs 33.5%; P <.0001), ICU admission (99.5% vs 89.2%; P <.001), and discharge rates to long-term care facilities (66.3% vs. 53.7%; P< .0001) compared with those meeting SIRS-based septic shock criteria. These results suggest prognostic superiority for the Sepsis-3 septic shock criteria among patients assessed by the RRT.
Prognostic accuracy of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) was also examined in comparison to the SIRS criteria for prediction of in-hospital mortality among patients with suspected infection. Of the eligible participants in the infected cohort, 26.9% met the qSOFA criteria compared with 81.4% who met the SIRS criteria. The qSOFA was found to have a sensitivity of 64.9% and a specificity of 92.2% for prediction of in-hospital mortality. Conversely, SIRS had a sensitivity of 91.6% and a specificity of 23.6% for prediction of in-hospital mortality. Therefore, in this context, the use of SIRS might confer advantage over qSOFA in predicting those patients at risk for death.
Disclosure: One study author (AJES) holds patents related to multiorgan variability analysis and reports having shares in Therapeutic Monitoring Systems Inc.
Fernando SM, Reardon PM, Rochwerg B, et al. Sepsis-3 septic shock criteria and associated mortality among infected hospitalized patients assessed by a rapid response team (published online May 17, 2018). CHEST. doi: 10.1016/j.chest.2018.05.004