Early diagnosis
Importance of early diagnosis
in patient outcomes
In the absence of an optimal biochemical marker and laboratory test to guide the
diagnosis of this critical condition in clinical practice, continuing education and protocol
testing are crucial elements in early sepsis diagnosis and stratification of severity
Jordi Rello MD PhD
Hospital Vall d’Hebron,
Barcelona, Spain
Sepsis and septic shock are known to cause
significant morbidity and mortality among
hospitalised patients despite slightly lower
mortality rate in developed countries in the
past two decades. 1 The International guidelines
of the Surviving Sepsis Campaign (SSC),
published in 2016, provide clear definitions
and recommendations for the diagnosis and
treatment of sepsis and also cover screening
procedures in order to allow for prompt
implementation of therapy. 2 However, early
recognition of the often non-specific signs and
symptoms (for example, hypovolaemia, blood
loss and pulmonary embolus, acute myocardial
infarction, diabetic ketoacidosis, and adrenal
insufficiency) of sepsis might not be
straightforward given the complexity and
heterogeneity of the clinical presentation
compared to other similar presentations in
patients treated in emergency departments.
Diagnosis can be particularly challenging when
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serious complications such as organ failure or
hypotension are not present, and this inability to
promptly diagnose may affect compliance with
the established institutional treatment guidelines
and result in delays in delivery of care, with
obvious negative consequences for patients. 3
Although many protocols are in place at
hospitals and critical care units to guide the
management of patients with sepsis and septic
shock, early screening may not always be
addressed in sufficient detail. The clinician’s
suspicion of infection is therefore critical for the
rapid assessment of presence of sepsis-related
organ failure and treatment initiation. A
combination of antibiotic and culture information
can be useful in the early identification of an
infection, which may have a significant positive
impact on mortality. The Sepsis-related Organ
Failure Assessment (SOFA) score and has been
recently improved to allow for an easier
identification of patients with suspected sepsis