Physicians at the University of Pittsburgh Medical Center and University of Pittsburgh School of Medicine recently published a series of articles in the Journal of the American Medical Association to bring clarity to sepsis. In the articles, an international task force provided updated definitions for sepsis and septic shock based on research from the Clinical Research, Investigation, and Systems Modeling of Acute illness Center at Pittsburgh School of Medicine and funded in part by NIH grants.
University of Pittsburgh scientists also published accompanying articles in Critical Care Medicine presenting a conceptual framework in which to apply the definitions.
Sepsis can affect up to 2 million patients in the United States each year and 1 in 10 sepsis patients do not survive, according to a press release from University of Pittsburgh School of Medicine and the University of Pittsburgh Medical Center (UPMC).
“Considerable advances have been made in the study and care of sepsis and septic shock in the past 15 years, and there is an urgent need to help the medical community do a better job identifying septic patients quickly and start life-saving treatment,” Derek C. Angus, MD, MPH, the Dr. Mitchell P. Fink Professor and chair of Pitt’s Department of Critical Care Medicine and practicing physician at UPMC, said in the release. “Put simply, sepsis is a life-threatening organ dysfunction due to a dysregulated response of the patient’s immune system to infection. Our intent is that this definition results in greater consistency for epidemiologic studies, clinical trials and – perhaps most important – better recognition and more timely management of patients with, or at risk of developing, sepsis.”
Angus is part of a task force created by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine in 2014. The team included 19 critical care, infectious disease, surgical and pulmonary specialists who suggested a reexamination of the definition of sepsis due to advancements in its pathophysiology, management and epidemiology.
The team also includes Christopher W. Seymour, MD, MSc, assistant professor in Pitt’s departments of Critical Care Medicine and Emergency Medicine and practicing physician at UPMC.
“Because sepsis is so complex, patients can present in many different ways. This can lead to delays in care and missed opportunities. The updated definition was crafted to help doctors and hospitals sort through the many sepsis symptoms and get to the diagnosis quickly,” Seymour said. “Unlike prior attempts to define sepsis, the task force sought data from real patients to inform their deliberations.”
Included among the new criteria is the “quick Sepsis-related Organ Failure Assessment” (qSOFA), a clinician guide for diagnosis and treatment of sepsis. The qSOFA prompt is based on analysis of more than 800,000 electronic health record encounters at 177 hospitals worldwide, according to the release.
The qSOFA criteria focus on three symptoms — altered mental status, fast respiratory rate and low blood pressure — which allows diagnosis without blood tests. Patients with infection who show two of the three criteria should be considered likely to be septic. Patients in this category account for more than 75% of infection-related deaths.
“This is the one of the largest collaborative studies ever conducted in the field of critical care medicine,” Seymour said. “The study results and Task Force Consensus definitions are endorsed by more than 25 professional medical and academic societies around the globe. As doctors and hospitals adopt the updated definition, there is the potential to more promptly recognize thousands of patients at risk of becoming, or who already are, septic.”
Angus DC, et al. JAMA. 2016;doi: 10.1001/jama.2016.0287.
Disclosure: Angus reports the work was supported by grants from the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, National Institute of General Medical Sciences grants GM104022 and GM107650 and National Heart, Lung, and Blood Institute grant HL123020.