What is the definition of severe sepsis (Systemic Inflammatory Response Syndrome)?

From the Guidelines

Severe sepsis is no longer a valid term and has been replaced by the term sepsis, which is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, with an increase in the SOFA score of 2 points or more 1.

Definition of Sepsis

The definition of sepsis has evolved over time, and the current definition, as per the Sepsis-3 guidelines, emphasizes the importance of organ dysfunction in the diagnosis of sepsis 1.

• Sepsis is characterized by a dysregulated host response to infection, leading to life-threatening organ dysfunction.
• The SOFA score is used to assess the degree of organ dysfunction, with an increase of 2 points or more indicating sepsis.
• The qSOFA score, which includes variables such as Glasgow Coma Scale score, systolic blood pressure, and respiratory rate, can be used to quickly identify patients at risk of sepsis 1.

Clinical Implications

The new definition of sepsis has significant clinical implications, as it emphasizes the importance of early recognition and treatment of sepsis to prevent progression to septic shock and multiple organ failure 1.

• Early identification of sepsis is crucial, and clinicians should be aware of the signs and symptoms of sepsis, including organ dysfunction and hypoperfusion.
• Prompt intervention with antibiotics, fluid resuscitation, and other supportive measures can significantly improve patient outcomes.
• The use of vasopressors, such as norepinephrine, may be necessary to maintain perfusion pressure in patients with septic shock 1.

Management of Sepsis

The management of sepsis involves a multidisciplinary approach, with a focus on early recognition, prompt intervention, and supportive care 1.

• Initial hemodynamic resuscitation should be achieved within 3 hours, with a focus on fluid therapy and vasopressor support as needed.
• Antibiotic therapy should be started promptly, with broad-spectrum antibiotics used initially and narrowed based on culture results.
• Supportive care, including mechanical ventilation and renal replacement therapy, may be necessary in patients with severe sepsis or septic shock.

From the Research

Definition of Severe Sepsis

• Severe sepsis is defined as sepsis associated with acute organ dysfunction 2, 3.
• It is also defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection 4.
• Organ dysfunction can be quantified using scoring systems such as the Sequential Organ Failure Assessment (SOFA) score 3, 4, 5.

Key Characteristics

• Severe sepsis can lead to circulatory shock refractory to fluid resuscitation alone, also known as septic shock 2.
• It requires early goal-directed therapy, adequate fluid resuscitation, and vasopressor/inotropic support 2.
• The SOFA score is used to assess the degree of organ dysfunction and predict mortality 3, 5.

Diagnosis and Management

• Diagnosis of severe sepsis involves identifying the source of infection and assessing organ dysfunction using scoring systems like SOFA 3, 5.
• Management includes rapid administration of antibiotics and fluids, as well as vasopressor therapy if necessary 2, 4, 5.
• The latest guidelines recommend starting antimicrobials within one hour of presentation, although this is controversial 5.