Clinical Evaluation of Sepsis-1 and Sepsis-3 in the Intensive Care Unit.
Chest. 2017 Jul 12;:
Authors: Fang X, Wang Z, Yang J, Cai H, Yao Z, Li K, Fang Q
BACKGROUND: There has been considerable controversy between sepsis-1 and sepsis-3 criteria.
METHODS: Patients with infection meeting SIRS ≥ 2 criteria (sepsis-1) or a SOFA score ≥ 2 (sepsis-3) on the first day after ICU admission were selected from the MIMIC-III database, and their outcomes were compared using all-cause death as the endpoint. Subgroup analysis was also performed based on prior chronic organ dysfunction.
RESULTS: 21,491 infected patients were included. Of those meeting the diagnostic criteria for sepsis-1, 13.42% did not satisfy sepsis-3 criteria, and this population had a 21-day mortality rate of 6.96%. In contrast, 7.00% of the patients meeting sepsis-3 criteria did not meet sepsis-1 criteria, and their 21-day mortality rate was 10.76%. When excluding preexisting organ conditions, 18.41% of sepsis-1 patients did not meet sepsis-3 criteria, with a 21-day mortality rate of 6.39%, and 6.00% of sepsis-3 patients did not meet sepsis-1 criteria, with a 21-day mortality rate of 9.11%. When SIRS ≥ 2 or SOFA ≥ 2 criteria were applied to predict 21-day all-cause mortality in infected patients without prior chronic organ dysfunction, the sensitivity was 96.0% or 91.0%, respectively. While the AUCs of both SOFA and SIRS criteria could be used for predicting mortality, SOFA score represented the severity of the condition, whereas SIRS score represented a clinically evident host response to infection.
CONCLUSIONS: Sepsis-3 diagnostic criteria narrow the sepsis population at the expense of sensitivity, and the resulting false negatives may delay disease diagnosis. It may be inappropriate to compare the prediction performance of SIRS and SOFA criteria when sepsis-3 is defined.
PMID: 28711593 [PubMed - as supplied by publisher]