New Sepsis and Septic Shock Definitions: Clinical Implications and Controversies

Chanu Rhee; Michael Klompas

doi:10.1016/j.idc.2017.05.001

New Sepsis and Septic Shock Definitions: Clinical Implications and Controversies

Infect Dis Clin North Am. 2017 Sep;31(3):397-413. doi: 10.1016/j.idc.2017.05.001. Epub 2017 Jul 5.

Authors

Chanu Rhee¹, Michael Klompas²

Affiliations

¹ Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA. Electronic address: crhee@bwh.harvard.edu.
² Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

PMID: 28687209
DOI: 10.1016/j.idc.2017.05.001

Abstract

New sepsis definitions shift emphasis from the systemic inflammatory response syndrome to organ dysfunction, quantified using the Sequential Organ Failure Assessment (SOFA) score. The new definitions also propose Quick SOFA criteria to rapidly identify potentially infected patients at risk for poor outcomes. The diagnosis of septic shock requires vasopressor dependence and increased lactate levels. Strengths of these definitions include their simplicity and clear association with adverse outcomes. However, their utility in identifying patients with serious infections before frank sepsis ensues remains to be seen. This article reviews challenges in defining sepsis, strengths and weaknesses of the new definitions, and unresolved issues.

Keywords: Clinical diagnosis; SIRS; SOFA; Sepsis; Septic shock; qSOFA.

Publication types

Review

MeSH terms

Emergency Service, Hospital
Hospital Mortality
Humans
Organ Dysfunction Scores*
Sepsis / diagnosis*
Shock, Septic / diagnosis*
Systemic Inflammatory Response Syndrome