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ORLANDO -- New sepsis and septic shock guidelines released here Monday should help clinicians identify at-risk patients earlier and more easily, but they are a work in progress based on an evolving understanding of sepsis pathophysiology, according to key members of the joint task force that developed them.
The revised sepsis definition shifts the diagnostic focus from infection with systemic inflammation to infection-triggered organ failure, and it does away with the systemic inflammatory response syndrome (SIRS) criteria, which have been used to diagnose sepsis for more than 2 decades.
In talks presented Monday afternoon at the , and in interviews with 鶹ý, two task force members discussed the challenges and limitations of the new definitions.
, of Northwell Health's Feinstein Institute for Medical Research in Manhasset, N.Y., said it is important for people evaluating the new definitions to understand that they are not intended to be the last word on the issue.
"Sepsis is a condition that, at this point in time, cannot truly be defined," he told 鶹ý. "We can't say with any real certainty that this is what sepsis is. What we can say is that we understand a great deal more about the pathobiology than we did in 1991 when the first definitions were put forward, and in 2001 when they were last revised."
The new guidelines recommend that physicians use of the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score to assess patients for sepsis in the ICU, with patients having diagnosed or suspected infection who also have an increase in SOFA score of 2 or more points from baseline meeting the criteria for sepsis.
Outside the ICU, a new, simplified evaluation process call quick SOFA (qSOFA) will help clinicians evaluate patients for suspected sepsis. The nonlaboratory assessment involves three components: altered mental state, systolic blood pressure of 100 mmHG or less, and respiration rate of 22 breaths per minute or more. If a patient has any two of these criteria they should be monitored closely, treated as needed, and possibly referred for more extensive testing.
"qSOFA is a tool that can be easily done at the patients bedside in just minutes," said European task force co-chair , of University College London.
The simplified assessment tool was developed using retrospective data analysis solely from databases in the U.S. Singer said the tool needs to be validated outside the U.S. in both developed and developing aeas.
"If there is prospective confirmation in a whole variety of health care settings then qSOFA may prove to be a really useful, valuable diagnostic tool, especially in (low resource) countries," he said.
In an interview with 鶹ý, Singer said the new definitions, known as Sepsis-3, were designed to be updated as more becomes known about sepsis and septic shock.
"There will definitely be a Sepsis-4," he said.
"This isn't the final answer. This is the next step in the process. As we learn more about sepsis pathobiology and diagnostics improve, the definition will change," he added. "We want people to do the research, to do the prospective validation, so that we can learn for the future."