The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
- PMID: 26903338
- PMCID: PMC4968574
- DOI: 10.1001/jama.2016.0287
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
Abstract
Importance: Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.
Objective: To evaluate and, as needed, update definitions for sepsis and septic shock.
Process: A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment).
Key findings from evidence synthesis: Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant.
Recommendations: Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less.
Conclusions and relevance: These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.
Conflict of interest statement
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Comment in
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New definition of sepsis and septic shock: What does it give us?Med Intensiva. 2017 Jan-Feb;41(1):38-40. doi: 10.1016/j.medin.2016.03.008. Epub 2016 May 30. Med Intensiva. 2017. PMID: 27255771 English, Spanish. No abstract available.
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[Intensive care studies from 2015/2016].Anaesthesist. 2016 Jul;65(7):532-52. doi: 10.1007/s00101-016-0188-x. Anaesthesist. 2016. PMID: 27324154 German. No abstract available.
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Conflicts of interest in the new consensus based definition of sepsis and septic shock (sepsis-3).Med Intensiva. 2017 Jan-Feb;41(1):60-61. doi: 10.1016/j.medin.2016.05.001. Epub 2016 Jun 28. Med Intensiva. 2017. PMID: 27370312 English, Spanish. No abstract available.
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Definitions for Sepsis and Septic Shock.JAMA. 2016 Jul 26;316(4):456-7. doi: 10.1001/jama.2016.6377. JAMA. 2016. PMID: 27458957 No abstract available.
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Definitions for Sepsis and Septic Shock.JAMA. 2016 Jul 26;316(4):457-8. doi: 10.1001/jama.2016.6374. JAMA. 2016. PMID: 27458959 No abstract available.
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Definitions for Sepsis and Septic Shock.JAMA. 2016 Jul 26;316(4):457. doi: 10.1001/jama.2016.6380. JAMA. 2016. PMID: 27458960 No abstract available.
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Definitions for Sepsis and Septic Shock.JAMA. 2016 Jul 26;316(4):458. doi: 10.1001/jama.2016.6368. JAMA. 2016. PMID: 27458961 No abstract available.
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Definitions for Sepsis and Septic Shock--Reply.JAMA. 2016 Jul 26;316(4):458-9. doi: 10.1001/jama.2016.6389. JAMA. 2016. PMID: 27458962 No abstract available.
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Composition of the Sepsis Definitions Task Force.JAMA. 2016 Jul 26;316(4):459-60. doi: 10.1001/jama.2016.6386. JAMA. 2016. PMID: 27458963 No abstract available.
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Composition of the Sepsis Definitions Task Force.JAMA. 2016 Jul 26;316(4):460. doi: 10.1001/jama.2016.6371. JAMA. 2016. PMID: 27458964 No abstract available.
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Composition of the Sepsis Definitions Task Force.JAMA. 2016 Jul 26;316(4):460-1. doi: 10.1001/jama.2016.6383. JAMA. 2016. PMID: 27458965 No abstract available.
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Composition of the Sepsis Definitions Task Force--Reply.JAMA. 2016 Jul 26;316(4):461-2. doi: 10.1001/jama.2016.6395. JAMA. 2016. PMID: 27458966 No abstract available.
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The new definitions of SEPSIS and SEPTIC SHOCK: What do they give us? An answer.Med Intensiva. 2017 Jan-Feb;41(1):41-43. doi: 10.1016/j.medin.2016.10.015. Epub 2017 Jan 17. Med Intensiva. 2017. PMID: 28108131 English, Spanish. No abstract available.
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Management of Sepsis and Septic Shock.JAMA. 2017 Feb 28;317(8):847-848. doi: 10.1001/jama.2017.0131. JAMA. 2017. PMID: 28114603 No abstract available.
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[Intensive care studies from 2016/2017].Anaesthesist. 2017 Sep;66(9):690-713. doi: 10.1007/s00101-017-0339-8. Anaesthesist. 2017. PMID: 28667421 Free PMC article. German. No abstract available.
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