Abstract | 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: 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 {CI} 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.
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Authors | Sandra L Peake, Anthony Delaney, Michael Bailey, Rinaldo Bellomo, ARISE Investigators |
Journal | Annals of emergency medicine
(Ann Emerg Med)
Vol. 70
Issue 4
Pg. 553-561.e1
(Oct 2017)
ISSN: 1097-6760 [Electronic] United States |
PMID | 28601273
(Publication Type: Journal Article)
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Copyright | Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. |
Chemical References |
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Topics |
- Advisory Committees
- Australia
- Biomarkers
(blood)
- Biomedical Research
(trends)
- Consensus
- Emergency Service, Hospital
- Female
- Finland
- Hong Kong
- Humans
- International Classification of Diseases
- Ireland
- Male
- Middle Aged
- New Zealand
- Organ Dysfunction Scores
- Resuscitation
(methods)
- Sepsis
(classification, diagnosis, mortality)
- Systemic Inflammatory Response Syndrome
(classification, diagnosis, mortality)
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