February 28, 2016
Each year more than one million Americans are stricken by sepsis, 28-50% of whom die from the underlying infection. This week, the Society of Critical Care Medicine (SCCM) published a new definition of septic shock and new criteria for identifying sepsis, with the aim of helping physicians identify patients with, or at high risk of developing, sepsis earlier on. As with most things in medicine, earlier identification means more opportunities for potentially life-saving treatment.
Previously, sepsis was defined as infection accompanied by the Systemic Inflammatory Response Syndrome, characterized by a high heart and respiratory rate, high white blood cell count, and fever. The new criteria, officially called the Quick Sepsis-Related Organ Failure Assessment Score (qSOFA), requires:
- Positive identification of infection
- At least two out of three “quick measures” (altered mental status, tachypnea, systolic hypotension)
- At least two positive organ failure assessment points
In particular, the SCCM expects that an emphasis on “quick measures,” rather than blood tests, will allow for more prompt identification of patients likely to become septic.
Furthermore, the SCCM has identified two criteria to aid physicians in identifying septic shock – a more severe form of sepsis accompanied by a greater risk of complications and mortality:
- Persistent hypotension with the inability to achieve a mean arterial pressure at or above 65mmHg without the use of vasopressors
- High blood lactate, even after fluid resuscitation (this criterion is new).
This new definition was applied in recent research based on the electronic medical records of more than 148,907 patients with suspected infection from hospitals around the world. The study debunked old criteria, the SIRS score, as the best measure of sepsis, and favored the new criteria instead.