Potential Impact of the 2016 Consensus Definitions of Sepsis and Septic Shock on Future Sepsis Research

Autor: H. White, L. Jones, Darsim Haji, H.S. Tan, Anthony Delaney, Michael F. Murphy, S. Arora, S. Scanlon, Ian Seppelt, Alexis Poole, D. Rajbhandari, Stephen T. Webb, Jamie Cooper, L. Peak, J A Wood, D. Powrie, A. Harney, James D Fratzia, Phoebe McCracken, K. Ryan, Michael Ragg, M. Franks, K. Kyneur, Christopher E. Trethewy, T. Coles, Erika Wilkman, David Gattas, S. Kelly, S. Knowles, Heidi Buhr, C. Rees, Alan S Tankel, L.F. Chang, J. Halkhoree, Emily C. O'Brien, N. Soar, S. Allsop, Brigit Roberts, P.K. Lam, E. Jenkinson, Jacob P. Kelly, Jan Mehrtens, Stephanie N. O'Connor, A. Purdue, T. Soulsby, Samantha Bates, Julie Burrows, Neil Orford, L. Moore, Sari Karlsson, Jasmine Board, John P. Dowling, Kavi Haji, E. Hickson, D. Barton, L. Chester, Christopher MacIsaac, H. Young, Helen Rodgers, D. Wilson, T. Sara, E. Meaney, Craig Winter, N. Ryan, Ville Pettilä, A. Delaney, S. Ankers, J. Cowell, Anne Kuitunen, J. Edington, J. Walsham, Tania Elderkin, D. Lightfoot, C. Tang, John D. Santamaria, G. Gordon, J. Vuat, H.M. So, Peter G. Jones, C. Kurenda, K. Shepherd, Anna Holdgate, S. Barrington-Onslow, A. Kukkurainen, Jayne Williams, A. Van Berkel, K. Isoardi, D. O’Flynn, Stuart N. Baker, Fergus Kerr, Craig French, S. Varila, D. Ghelani, A. Dimakis, S. Sutinen, Kevin L. Thomas, E. Farone, M. Keir, T. Lamac, Charles D. Gomersall, Jyrki Tenhunen, B. Lancashire, V. Nanjayya, Sandra L. Peake, K. Gorman, Claire Reynolds, D. Stewart, Julian A. Smith, Yahya Shehabi, Natasha Woodward, Craig Walker, Javed Butler, D. Hutch, E. Yarad, L. Shields, T. Jewell, T. Otto, K. Nand, K. Milburn, F. Sawtell, Adrian J. T. Teo, V. Raniga, T. Fogg, J. Dennett, Robert Millar, E. Fulton, H. Connor, W.W. Yan, A. O’Connor, Steven McGloughlin, R. Wells, A. Ankor, R. Harris, Imogen Mitchell, Allison Bone, J.H. Greenslade, K. Sundararajan, H. Wu, Alistair Nichol, Marjatta Okkonen, J. Chamberlain, D. Flemming, Julie Smith, A. Altea, D. Rainsford, E. Hill, S. Vij, Priya Nair, Deborah A Williamson, Jeremy Furyk, J. McCabe, Frances Bass, M. Grummisch, H.F. Ho, Seton J Henderson, A. Leung, W.S. Cheung, A. Finckh, A. Tippett, Michael Parr, S. Bird, J. Coakley, A. Tilsley, Bilal Ahmed, Christine Jenkins, R. Song, A. Jordan, Laurie J. Morrison, K. Braid, J. Dryburgh, Veli-Pekka Harjola, S.K. Fok, C. Hogan, George Braitberg, A. Williams, Victoria L. Bennett, S. Lawrence, S. Treloar, K. Sosnowski, Sharon Micallef, T. Sandford, M. Vellaichamy, J. Kwans, Glenn M Eastwood, Patricia Williams, Jennifer Holmes, Ellen McDonald, Simon G A Brown, P. Galt, R. Ramadoss, T. DeVillecourt, Michael Davies, Anthony Cross, Rinaldo Bellomo, S. Senthuran, R. Bellomo, Michael Bailey, J. Crosdale, B. O’Bree, S.M. Lam, David J Hawkins, S. Bolch, Colin A. Graham, J. Isoardi, P. Leung, J. Townsend, K. Schimanski, S. Peake, Jason Fletcher, K. Grove
Přispěvatelé: Clinicum, Department of Diagnostics and Therapeutics, Anestesiologian yksikkö, HUS Perioperative, Intensive Care and Pain Medicine
Rok vydání: 2016
Předmět:
Male
medicine.medical_specialty
Randomization
Biomedical Research
Consensus
Organ Dysfunction Scores
Resuscitation
Advisory Committees
030204 cardiovascular system & hematology
Sepsis
03 medical and health sciences
0302 clinical medicine
International Classification of Diseases
Internal medicine
Post-hoc analysis
SCORE
medicine
Humans
030212 general & internal medicine
Intensive care medicine
Finland
Septic shock
business.industry
Australia
CLINICAL-CRITERIA
Emergency department
Middle Aged
medicine.disease
3126 Surgery
anesthesiology
intensive care
radiology
Confidence interval
Systemic Inflammatory Response Syndrome
3. Good health
Systemic inflammatory response syndrome
Emergency Medicine
Hong Kong
Hyperlactatemia
Female
business
ORGAN FAILURE
Emergency Service
Hospital
Ireland
Biomarkers
New Zealand
Zdroj: Annals of emergency medicine. 70(4)
ISSN: 1097-6760
Popis: V. Pettilä on työryhmän ARISE Investigators jäsen. Study objective: The influence of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) on the conduct of future sepsis research is unknown. We seek to examine the potential effect of the new definitions on the identification and outcomes of patients enrolled in a sepsis trial. Methods: This was a post hoc analysis of the Australasian Resuscitation in Sepsis Evaluation (ARISE) trial of early goal-directed therapy that recruited 1,591 adult patients presenting to the emergency department (ED) with early septic shock diagnosed by greater than or equal to 2 systemic inflammatory response syndrome criteria and either refractory hypotension or hyperlactatemia. The proportion of participants who would have met the Sepsis-3 criteria for quick Sequential Organ Failure Assessment (qS0FA) score, sepsis (an increased Sequential Organ Failure Assessment score >= 2 because of infection) and septic shock before randomization, their baseline characteristics, interventions delivered, and mortality were determined. Results: There were 1,139 participants who had a qSOFA score of greater than or equal to 2 at baseline (71.6% [95% confidence interval [Cl) 69.4% to 73.8%]). In contrast, 1,347 participants (84.7% [95% CI 82.9% to 86.4%]) met the Sepsis-3 criteria for sepsis. Only 1,010 participants were both qSOFA positive and met the Sepsis-3 criteria for sepsis (63.5% [95% CI 61.1% to 65.8%]). The Sepsis-3 definition for septic shock was met at baseline by 203 participants (12.8% [95% CI 11.2% to 14.5%]), of whom 175 (86.2% [95% CI 81.5% to 91.0%]) were also qSOFA positive. Ninety-day mortality for participants fulfilling the Sepsis-3 criteria for sepsis and septic shock was 20.4% (95% CI 18.2% to 22.5%) (274/1,344) and 29.6% (95% CI 23.3% to 35.8% [60/203]) versus 9.4% (95% CI 5.8% to 13.1%) (23/244) and 17.1% (95% CI 15.1% to 19.1% [237/1,388]), respectively, for participants not meeting the criteria (risk differences 11.0% [95% CI 6.2% to 14.8%] and 12.5% [95% CI 6.3% to 19.4%], respectively). Conclusion: Most ARISE participants did not meet the Sepsis-3 definition for septic shock at baseline. However, the majority fulfilled the new sepsis definition and mortality was higher than for participants not fulfilling the criteria. A quarter of participants meeting the new sepsis definition did not fulfill the qSOFA screening criteria, potentially limiting its utility as a screening tool for sepsis trials with patients with suspected infection in the ED. The implications of the new definitions for patients not eligible for recruitment into the ARISE trial are unknown.
Databáze: OpenAIRE
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