Do Sepsis-3 criteria facilitate earlier recognition of sepsis and septic shock? A retrospective cohort study

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Abstract

Background:

New Sepsis-3 criteria are supposed to “facilitate earlier recognition…of patients with sepsis”. To test this, we performed novel and direct comparisons of Sepsis-1 vs. Sepsis-3 criteria with respect to time differences of sepsis onset.

Methods:

In a cohort of intensive care unit (ICU) patients prospectively diagnosed with severe sepsis or septic shock according to Sepsis-1 criteria between 01/2010–12/2015 the time differences between meeting Sepsis-1 vs. Sepsis-3 criteria as time of sepsis onset and the corresponding differences in illness severity were tested. Similar comparisons were performed for septic shock subset meeting different Sepsis-1 vs. Sepsis-3 criteria. Patients with non-ICU acquired sepsis and patients with sepsis onset > 48 h post admission (ICU acquired sepsis) were analyzed separately to account for differences in availability of routinely collected organ dysfunction data.

Results:

10905 ICU patients were screened. 862 patients met Sepsis-1 criteria, of whom 834 (97%) also met Sepsis-3 criteria. In patients, admitted to the ICU with sepsis, Sepsis-3 criteria compared to Sepsis-1 criteria were more frequently fulfilled within the first 3 hours (84% vs. 75%, P < 0.001).

Results:

In patients with ICU acquired sepsis, sepsis onset was in 50% at least one day earlier after application of Sepsis-3(P = 0.011). These patients were SIRS negative at the earlier sepsis onset, but suffered already from organ dysfunction. Sepsis-3 criteria were timely in 86% and one day delayed in 7%. Only 7% (8 patients) did not meet Sepsis-3 criteria in this group. These patients had already an increased SOFA score and did develop neither a further increase nor the new septic shock criteria. Classification according to Sepsis-3 reduced the proportion of septic shock (51% vs. 75%, P < 0.001).

Results:

28-day mortality was 38% for new septic shock compared to 33% of Sepsis-1 septic shock (P > 0.05). Patients not detected by Sepsis-3 had a 28-day mortality of 11%.

Conclusions:

Sepsis-3 criteria facilitate an earlier and more predictive recognition of sepsis and septic shock in patients with non-ICU and ICU acquired sepsis primarily diagnosed by Sepsis-1 criteria. These results require further validation with prospectively collected data.

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