Sepsis-3 Septic Shock Criteria and Associated Mortality Among Infected Hospitalized Patients Assessed by a Rapid Response Team.
Chest. 2018 May 17;:
Authors: Fernando SM, Reardon PM, Rochwerg B, Shapiro NI, Yealy DM, Seely AJE, Perry JJ, Barnaby DP, Murphy K, Tanuseputro P, Kyeremanteng K
BACKGROUND: Rapid Response Teams (RRTs) respond to deteriorating hospitalized patients, and help determine subsequent management, including Intensive Care Unit (ICU) admission. In such patients with sepsis and septic shock, the Sepsis-3 clinical criteria have a potential role in detection, risk-stratification, and prognostication, though their accuracy in comparison to the Systemic Inflammatory Response Syndrome (SIRS)-based septic shock criteria are unknown. We sought to evaluate prognostic accuracy of the Sepsis-3 criteria for in-hospital mortality among infected hospitalized patients with acute deterioration.
METHODS: Prospectively collected registry data (2012-2016) from two hospitals, and including consecutive hospitalized patients with suspected infection seen by the RRT. We compared Sepsis-3 criteria against the SIRS-based criteria for prediction of in-hospital mortality.
RESULTS: Of 1,708 included patients, 418 (24.5%) met Sepsis-3 septic shock criteria, while 545 (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<0.0001), ICU admission (99.5% vs. 89.2%; P<0.001), and discharge rates to long-term care (66.3% vs. 53.7%; P<0.0001), compared to the SIRS-based septic shock criteria. Sensitivity and specificity of quick Sequential Organ Failure Assessment (qSOFA) was 64.9% and 92.2% for prediction of in-hospital mortality, while SIRS had a sensitivity and specificity of 91.6% and 23.6%, respectively.
CONCLUSIONS: Hospitalized patients with deterioration from suspected infection had higher risk of in-hospital mortality if they met the Sepsis-3 septic shock criteria, as compared to the SIRS-based septic shock criteria. Therefore, use of Sepsis-3 criteria may be preferable in the prognostication and disposition of these critically ill patients.
PMID: 29778659 [PubMed - as supplied by publisher]