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New sepsis definition changes incidence of sepsis in the intensive care unit
James N Fullerton1, Kelly Thompson2, Amith Shetty3
1Division of Critical Care and Trauma, The George Institute for Global Health, Sydney, NSW, Australia. kthompson@georgeinstitute.org.au.
Objective:
To estimate the impact of adopting the proposed new diagnostic criteria for sepsis, based on Sequential Organ Failure Assessment (SOFA) criteria, on the diagnosis and apparent mortality of sepsis in Australian and New Zealand intensive care units.
Design, Setting And Participants:
A two-stage, post hoc analysis of prospectively collected ICU research data from 3780 adult patients in 77 Australian and New Zealand ICUs on 7 study days, between 2009 and 2014.
Main Outcome Measures:
The proportion of patients who were diagnosed with sepsis using the criteria for systemic inflammatory response syndrome (SIRS) and who met the SOFA criteria for sepsis, and the proportion of patients who were admitted to the ICU with a diagnosis consistent with infection, who met either, both or neither sets of criteria for sepsis; comparison of the demographic differences and in-hospital mortality between these groups.
Results:
Of 926 patients diagnosed with sepsis on a study day using SIRS criteria, 796/923 (86.2% [95% CI, 84.0%-88.5%]) satisfied the SOFA criteria. Inhospital mortality was similar in these groups, with death recorded for 216/872 patients (24.8% [95% CI, 21.9%-27.8%]) who met the SIRS criteria for sepsis, and for 200/747 patients (26.8% [95% CI, 23.6%-30.1%]) who met both the SIRS and SOFA criteria for sepsis. Of 122 patients meeting the SIRS criteria but not the SOFA criteria, 16 (13.1% [95% CI, 7.7%-19.1%]) died. Of 241 patients admitted with an infective condition and complete data, 142 (58.9% [95% CI, 52.4%-65.2%]) satisfied the SIRS criteria for sepsis and 210 (87.1% [95% CI, 82.2%-91.1%]) satisfied the SOFA criteria. Of the 241 patients, 99 (41.1%) were not classified as having sepsis on the study day by SIRS criteria and, of these, 80 (80.8%) met the SOFA criteria.
Conclusions:
Adopting the SOFA criteria will increase the apparent incidence of sepsis in patients admitted to the ICU with infective conditions without affecting the mortality rate. Prospective evaluation of the effect of adopting the new definition of sepsis is required.
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