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Sepsis mimics among presumed sepsis patients at intensive care admission: a retrospective observational study
Maria Lengquist1,2, Anjali Varadarajan3,4, Shiva Alestam3,4
1Department of Clinical Medicine, Lund University, Lund, Sweden. maria.lengquist@med.lu.se.
Background:
Diagnosing sepsis remains a challenge because of the lack of gold-standard diagnostics. Since there are no simple, broadly accepted criteria for infection, there is a risk of misclassifying sepsis patients (sepsis mimics) among patients with organ failure. The main objective of this study was to investigate the proportion of non-infected patients (sepsis mimics) in ICU patients with presumed sepsis at intensive care unit (ICU) admission.
Methods:
Adult patients were screened retrospectively during 3.5 years in four ICUs in Sweden for fulfilment of the sepsis-3 criteria at ICU admission (presumed sepsis). Proxy criteria for suspected infection were sampled blood culture(s) and concomitant antibiotic administration. Culture-negative presumed sepsis patients were screened for infection according to the Linder-Mellhammar Criteria of Infection (LMCI). Sepsis mimics were defined as without probable infection according to the LMCI. Confirmed sepsis was defined as presumed sepsis after the exclusion of sepsis mimics.
Results:
In the ICU presumed sepsis cohort (2664 patients), 25% were considered sepsis mimics. The most common reasons for ICU admission among sepsis mimics were acute heart failure and unspecific respiratory failure. Comparing sepsis mimics and confirmed sepsis showed that confirmed sepsis patients were slightly more severely ill but had similar mortality. C-reactive protein had modest discriminatory power (AUROC 0.71) with confirmed sepsis as the outcome.
Conclusions:
One-fourth of a presumed ICU sepsis population identified with the sepsis-3 criteria could be considered sepsis mimics. The high proportion of sepsis mimics has a potential dilutional effect on the presumed sepsis population, which threatens the validity of results from sepsis studies using recommended sepsis criteria.
Insights
Diagnosing sepsis is difficult, and this study found that one-fourth of presumed sepsis patients in the ICU were actually sepsis mimics. This high rate of sepsis mimics may affect the accuracy of sepsis research.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Diagnostic Accuracy
Background:
- Accurate sepsis diagnosis is challenging due to the absence of gold-standard tests.
- Sepsis mimics, non-infected patients with organ failure, are often misclassified.
- This misclassification risks the validity of sepsis research.
Purpose of the Study:
- To determine the proportion of sepsis mimics among patients with presumed sepsis upon intensive care unit (ICU) admission.
- To evaluate the impact of sepsis mimics on sepsis diagnostic criteria.
Main Methods:
- Retrospective analysis of adult patients in four Swedish ICUs over 3.5 years.
- Application of sepsis-3 criteria for presumed sepsis and Linder-Mellhammar Criteria of Infection (LMCI) for infection confirmation.
- Sepsis mimics defined as presumed sepsis patients without probable infection per LMCI.
Main Results:
- 25% of the presumed sepsis cohort (2664 patients) were identified as sepsis mimics.
- Acute heart failure and unspecific respiratory failure were common reasons for ICU admission in sepsis mimics.
- Confirmed sepsis patients were slightly more severely ill but had similar mortality rates compared to sepsis mimics.
Conclusions:
- A significant proportion (one-fourth) of ICU patients meeting sepsis-3 criteria may be sepsis mimics.
- The presence of sepsis mimics can dilute findings in sepsis studies, potentially compromising their validity.
- Refined diagnostic approaches are needed to improve sepsis diagnosis accuracy in ICUs.
