HHE Sponsored supplement: Sepsis | Page 6

The combination of fluid-resistant hypotension requiring vasopressors and hyperlactataemia is associated with a mortality of 42.3% above moderate diagnostic value for sepsis. 23 These were procalcitonin, C-reactive protein, interleukin 6, soluble triggering receptor expressed on myeloid cells-1, presepsin, lipopolysaccharide-binding protein and CD64. Further research is necessary to identify biomarkers with higher sensitivity/specificity, or a combination of multiple biomarkers. score from the patient’s baseline. The qSOFA score can aid clinicians in the identification of those patients with infection who are at higher risk of poor outcomes, however, qSOFA should not be used as a diagnostic tool for sepsis. Septic shock is a subset of sepsis with profound circulatory, cellular and metabolic abnormalities, which is identified clinically as the requirement for vasopressors to maintain a mean blood pressure ≥65mmHg and ongoing hyperlactataemia despite adequate fluid resuscitation. 3 Further research is necessary to identify biomarkers with higher sensitivity and specificity for the diagnosis of sepsis. Conclusions Sepsis represents a life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be measured using a change ≥2 points in the SOFA References 1 Fleischmann C et al; International Forum of Acute Care Trialists. Assessment of global incidence and mortality of hospital-treated sepsis: current estimates and limitations. Am J Respir Crit Care Med 2016;193:259–72. 2 Reinhart K et al. Recognizing sepsis as a global health priority – a WHO resolution. N Engl J Med 2017;377:414–17. 3 Singer M et al. The Third International Consensus Definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801–10. 4 Bone RC et al; ACCP/SCCM Consensus Conference Committee; American College of Chest Physicians/Society of Critical Care Medicine. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644–55. 5 Levy MM et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250–6. 6 Sprung CL et al. An evaluation of systemic inflammatory response syndrome signs in the Sepsis Occurrence in Acutely Ill Patients (SOAP) Study. Intensive Care Med 2006;32:421–7. 7 Kaukonen KM et al. Systemic Inflammatory Response Syndrome criteria in defining severe sepsis. N Engl J Med 2015;372:1629–38. 8 Vincent JL et al; Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/ failure. Intensive Care Med 1996;22:707–10. 9 Seymour CW et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:762–74. 10 Singer M, Shankar-Hari M. qSOFA, cue confusion. Ann Intern Med 2018;168:293–95. 11 Matics TJ, Sanchez-Pinto N. Adaptation and validation of a pediatric Sequential Organ Failure Assessment score and evaluation of the Sepsis-3 definitions in critically ill children. JAMA Pediatr 2017;171:e172352. 12 Rudd KE et al. Association of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score with excess hospital mortality in adults with suspected infection in low- and middle-income countries. JAMA 2018;319: 2202–11. 13 Shankar-Hari M et al. 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Intensive Care Med 2013;39:165–228. 20 Angus DC et al. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001;29:1303–10. 21 Klein Klouwenberg PMC et al. Likelihood of infection in patients with presumed sepsis at the time of intensive care unit admission: a cohort study. Crit Care 2015;19:319. 22 Casserly B et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med 2015;43:567–73. 23 Liu Y et al. Biomarkers for diagnosis of sepsis in patients with systemic inflammatory response syndrome: a systematic review and meta-analysis. Springerplus 2016; 5:2091.