Rethinking the concept of sepsis and septic shock

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Clinical Practice Guidelines

Background:

• Sepsis and septic shock are significant global health challenges.
• Updated management guidelines and definitions for sepsis and septic shock were published in 2016 (Sepsis-3).
• Existing diagnostic criteria present challenges in clinical application.

Purpose of the Study:

• To compare the new Sepsis-3 criteria with previous definitions.
• To propose an alternative approach for early sepsis identification.
• To discuss the utility and limitations of SOFA and qSOFA criteria.

Main Methods:

• Narrative review of current literature and guidelines.
• Comparison of Sequential Organ Failure Assessment (SOFA) criteria with systemic inflammatory response syndrome (SIRS) criteria.
• Evaluation of quick SOFA (qSOFA) for clinical applicability.

Main Results:

• SOFA criteria are comprehensive but often impractical outside intensive care units, potentially delaying treatment.
• qSOFA criteria are easily applicable but may lack sensitivity.
• SIRS criteria are widely used but may not be specific enough.

Conclusions:

• A combined approach using qSOFA and SIRS criteria could facilitate earlier identification of infected patients requiring prompt treatment.
• This hybrid method leverages the strengths of both old and new diagnostic criteria.
• Further research is needed to develop optimal tools for rapid sepsis detection.