By Diagnostics World Staff
February 25, 2016 | A task force uniting members of the international Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine has reevaluated the clinical definition of sepsis in a study published this week in The Journal of the American Medical Association. The task force produced new diagnostic criteria for sepsis, which the authors believe will both increase the rate at which the condition is recognized, and make it easier to diagnose in emergency situations outside of hospitals.
The standard medical definition of sepsis, which occurs when an uncontrolled infection triggers a dangerous immune response, has not been significantly revised since 1991, when the SCCM participated in a conference that linked the condition explicitly to inflammation. A set of diagnostic criteria called SIRS (systemic inflammatory response syndrome) has been used in hospitals ever since. In this system, sepsis is diagnosed based on a patient’s temperature, heart rate, respiratory rate, and white blood cell count. The guidelines were designed to give clinicians a shorthand way to identify sepsis cases quickly and begin treatment early, even as the huge variety of infections that can lead to sepsis makes it impossible to create a single diagnostic test.
The problem is an urgent one, as unaddressed sepsis can quickly progress to organ failure; the syndrome is the leading cause of death from infection.
However, there have been few reviews of whether the SIRS criteria are in fact successful at catching sepsis cases and improving patient survival. The task force undertook a review of electronic health records, to see whether alternative criteria could better predict patients’ course of illness―particularly, admission to the intensive care unit or death.
As a result of this analysis, the authors propose replacing SIRS with another existing diagnostic formula focused less on inflammation, and more on organ failure. The SOFA (sequential organ failure assessment) criteria include lab test results like platelet and creatinine levels, in addition to respiration rate, arterial pressure, and a cognitive score. In a retroactive study of health records, using this system cut the rate of fatal sepsis cases that went unidentified from 35% to 25%.
The task force also devised a shorthand version of the test called qSOFA, which produced almost the same results in non-ICU settings without the need for lab tests. The authors recommend that qSOFA be used in ambulances and other situations where lab tests are not quickly available, to identify when infections are progressing to sepsis, and as a warning sign that a patient may have an undiagnosed infection.