The Impact of the Sepsis-3 Septic Shock Definition on Previously Defined Septic Shock Patients.
Crit Care Med
; 45(9): 1436-1442, 2017 Sep.
Article
em En
| MEDLINE
| ID: mdl-28542029
ABSTRACT
OBJECTIVE:
The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the "old" (1991) criteria of septic shock only.DESIGN:
Secondary analysis of two clinical trials of early septic shock resuscitation.SETTING:
Large academic emergency departments in the United States. PATIENTS Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90 mm Hg after fluid resuscitation.INTERVENTIONS:
Patients were further categorized as Sepsis-3 septic shock if they demonstrated hypotension, received vasopressors, and exhibited a lactate greater than 2 mmol/L. We compared in-hospital mortality in patients who met the old definition only with those who met the Sepsis-3 criteria. MEASUREMENTS AND MAINRESULTS:
Four hundred seventy patients were included in the present analysis. Two hundred (42.5%) met Sepsis-3 criteria, whereas 270 (57.4%) met only the old definition. Patients meeting Sepsis-3 criteria demonstrated higher severity of illness by Sequential Organ Failure Assessment score (9 vs 5; p < 0.001) and mortality (29% vs 14%; p < 0.001). Subgroup analysis of 127 patients meeting only the old definition demonstrated significant mortality benefit following implementation of a quantitative resuscitation protocol (35% vs 10%; p = 0.006).CONCLUSION:
In this analysis, 57% of patients meeting old definition for septic shock did not meet Sepsis-3 criteria. Although Sepsis-3 criteria identified a group of patients with increased organ failure and higher mortality, those patients who met the old criteria and not Sepsis-3 criteria still demonstrated significant organ failure and 14% mortality rate.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Choque Séptico
/
Serviço Hospitalar de Emergência
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Guideline
/
Prognostic_studies
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Crit Care Med
Ano de publicação:
2017
Tipo de documento:
Article