The Task Force has developed new definitions that include an updated understanding of sepsis, including organ dysfunction (Box 3). However, the absence of a criterion standard, similar to many other syndemic conditions, precludes clear validation and instead requires rough estimates of performance across a large number of validity domains, as described above. To help the clinician on his hospital bed and possibly cause an escalation of care if it has not already been introduced, simple clinical criteria (QSOFA) have been developed to identify patients suspected of an infection who are likely to have poor outcomes, i.e. a longer intensive course and death. The task force tried to distinguish sepsis from simple infection and to update the definitions of sepsis and septic shock to be compatible with a better understanding of pathobiology. A definition is the description of a disease concept; Therefore, a definition of sepsis should describe what sepsis is. This approach made it possible to discuss biological concepts that are currently poorly understood, such as genetic influences and cellular abnormalities. The concept of sepsis is based on infection as a trigger and recognizes the current challenges in microbiological identification of infections. However, it was not for the Task Force to study the definitions of infections. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host reaction to infection (Box 3).
This new definition highlights the primacy of the non-homeostatic host response to an infection, the potential lethality, which goes far beyond a simple infection, and the need for urgent recognition. As described later, even a modest degree of organ dysfunction in case of the first suspicion of infection is associated with mortality in hospital above 10%. Recognition of this condition therefore deserves a rapid and appropriate response. What made you look septically? Please let us know where you read or heard it (including the quote, if possible). At a consensus conference in 199199, the first definitions were developed focusing on the prevailing view at the time that sepsis was due to systemic inflammatory reaction syndrome (SIRS) from a host to an infection (Box 1). Sepsis, complicated by organ dysfunction, has been called severe sepsis that can cause septic shock, defined as “sepsis-induced hypotension that persists despite sufficient fluid resuscitation.” A 2001 task force, which recognised the limitations of these definitions, expanded the list of diagnostic criteria, but did not propose other solutions due to the lack of supporting evidence10 In fact, the definitions of sepsis, septic shock and organ dysfunction have remained broadly unchanged for more than two decades. This approach has important epidemiological and investigative implications. The proposed criteria should support diagnostic categorization as soon as the immediate initial assessment and management has been completed. QSOFA or SOFA can be used at one time or another as entry criteria into clinical trials. There is a potential conflict with current organ dysfunction scoring systems, early warning values, ongoing research studies and trail developments. Many of these scores and pathways have been developed by consensus, while an important aspect of current work is consulting data, although retrospectively, with large patient populations. The task force states that standardisation of definitions and clinical criteria is essential to ensure clear communication and a more accurate assessment of the extent of the sepsis problem.
Another challenge is that the infection is rarely microbiologically confirmed when treatment is started. even when microbiological tests are completed, culturally positive “sepsis” is observed in only 30-40% of cases….