Robustness of sepsis-3 criteria in critically ill patients

BACKGROUND: Early recognition of sepsis is challenging, and diagnostic criteria have changed repeatedly. We assessed the robustness of sepsis-3 criteria in intensive care unit (ICU) patients. METHODS: We studied the apparent incidence and associated mortality of sepsis-3 among patients who were pros...

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Autores principales: Verboom, Diana M., Frencken, Jos F., Ong, David S. Y., Horn, Janneke, van der Poll, Tom, Bonten, Marc J. M., Cremer, Olaf L., Klein Klouwenberg, Peter M. C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716896/
https://www.ncbi.nlm.nih.gov/pubmed/31489199
http://dx.doi.org/10.1186/s40560-019-0400-6
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author Verboom, Diana M.
Frencken, Jos F.
Ong, David S. Y.
Horn, Janneke
van der Poll, Tom
Bonten, Marc J. M.
Cremer, Olaf L.
Klein Klouwenberg, Peter M. C.
author_facet Verboom, Diana M.
Frencken, Jos F.
Ong, David S. Y.
Horn, Janneke
van der Poll, Tom
Bonten, Marc J. M.
Cremer, Olaf L.
Klein Klouwenberg, Peter M. C.
author_sort Verboom, Diana M.
collection PubMed
description BACKGROUND: Early recognition of sepsis is challenging, and diagnostic criteria have changed repeatedly. We assessed the robustness of sepsis-3 criteria in intensive care unit (ICU) patients. METHODS: We studied the apparent incidence and associated mortality of sepsis-3 among patients who were prospectively enrolled in the Molecular Diagnosis and Risk Stratification of Sepsis (MARS) cohort in the Netherlands, and explored the effects of minor variations in the precise definition and timing of diagnostic criteria for organ failure. RESULTS: Among 1081 patients with suspected infection upon ICU admission, 648 (60%) were considered to have sepsis according to prospective adjudication in the MARS study, whereas 976 (90%) met sepsis-3 criteria, yielding only 64% agreement at the individual patient level. Among 501 subjects developing ICU-acquired infection, these rates were 270 (54%) and 260 (52%), respectively (yielding 58% agreement). Hospital mortality was 234 (36%) vs 277 (28%) for those meeting MARS-sepsis or sepsis-3 criteria upon presentation (p < 0.001), and 121 (45%) vs 103 (40%) for those having sepsis onset in the ICU (p < 0.001). Minor variations in timing and interpretation of organ failure criteria had a considerable effect on the apparent prevalence of sepsis-3, which ranged from 68 to 96% among those with infection at admission, and from 22 to 99% among ICU-acquired cases. CONCLUSION: The sepsis-3 definition lacks robustness as well as discriminatory ability, since nearly all patients presenting to ICU with suspected infection fulfill its criteria. These should therefore be specified in greater detail, and applied more consistently, during future sepsis studies. TRIAL REGISTRATION: The MARS study is registered at ClinicalTrials.gov (identifier NCT 01905033). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-019-0400-6) contains supplementary material, which is available to authorized users.
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spelling pubmed-67168962019-09-05 Robustness of sepsis-3 criteria in critically ill patients Verboom, Diana M. Frencken, Jos F. Ong, David S. Y. Horn, Janneke van der Poll, Tom Bonten, Marc J. M. Cremer, Olaf L. Klein Klouwenberg, Peter M. C. J Intensive Care Research BACKGROUND: Early recognition of sepsis is challenging, and diagnostic criteria have changed repeatedly. We assessed the robustness of sepsis-3 criteria in intensive care unit (ICU) patients. METHODS: We studied the apparent incidence and associated mortality of sepsis-3 among patients who were prospectively enrolled in the Molecular Diagnosis and Risk Stratification of Sepsis (MARS) cohort in the Netherlands, and explored the effects of minor variations in the precise definition and timing of diagnostic criteria for organ failure. RESULTS: Among 1081 patients with suspected infection upon ICU admission, 648 (60%) were considered to have sepsis according to prospective adjudication in the MARS study, whereas 976 (90%) met sepsis-3 criteria, yielding only 64% agreement at the individual patient level. Among 501 subjects developing ICU-acquired infection, these rates were 270 (54%) and 260 (52%), respectively (yielding 58% agreement). Hospital mortality was 234 (36%) vs 277 (28%) for those meeting MARS-sepsis or sepsis-3 criteria upon presentation (p < 0.001), and 121 (45%) vs 103 (40%) for those having sepsis onset in the ICU (p < 0.001). Minor variations in timing and interpretation of organ failure criteria had a considerable effect on the apparent prevalence of sepsis-3, which ranged from 68 to 96% among those with infection at admission, and from 22 to 99% among ICU-acquired cases. CONCLUSION: The sepsis-3 definition lacks robustness as well as discriminatory ability, since nearly all patients presenting to ICU with suspected infection fulfill its criteria. These should therefore be specified in greater detail, and applied more consistently, during future sepsis studies. TRIAL REGISTRATION: The MARS study is registered at ClinicalTrials.gov (identifier NCT 01905033). ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40560-019-0400-6) contains supplementary material, which is available to authorized users. BioMed Central 2019-08-29 /pmc/articles/PMC6716896/ /pubmed/31489199 http://dx.doi.org/10.1186/s40560-019-0400-6 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Verboom, Diana M.
Frencken, Jos F.
Ong, David S. Y.
Horn, Janneke
van der Poll, Tom
Bonten, Marc J. M.
Cremer, Olaf L.
Klein Klouwenberg, Peter M. C.
Robustness of sepsis-3 criteria in critically ill patients
title Robustness of sepsis-3 criteria in critically ill patients
title_full Robustness of sepsis-3 criteria in critically ill patients
title_fullStr Robustness of sepsis-3 criteria in critically ill patients
title_full_unstemmed Robustness of sepsis-3 criteria in critically ill patients
title_short Robustness of sepsis-3 criteria in critically ill patients
title_sort robustness of sepsis-3 criteria in critically ill patients
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716896/
https://www.ncbi.nlm.nih.gov/pubmed/31489199
http://dx.doi.org/10.1186/s40560-019-0400-6
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