Do we need a new definition of sepsis?

Excerpt

Of all critical care conditions, sepsis has shaped health policy, dominated the research agenda, and entered the public lexicon with energetic, high profile educational campaigns vowing to reduce the attendant mortality. Yet, when asked to provide a concise definition, even practitioners who treat ‘septic’ patients may struggle. A consensus conference convened in 1992 characterized sepsis as a syndrome of presumed or confirmed infection and at least two of four systemic inflammatory response syndrome (SIRS) criteria [1]. However, though sensitive, this collection of non-validated variables lacks specificity. Indeed, most patients admitted to critical care units are SIRS-positive while the presumption of infection is a default diagnosis that is frequently adopted but often not confirmed. The second consensus conference, sitting in 2001, compounded the specificity issue by maintaining the 1992 illness construct yet further extending the list of clinical and laboratory variables to describe the protean manifestations of the host response to infection [2]. In addition, a proliferation of other definitions created to suit trial entry criteria, management guidelines, and retrospective analyses of databases have led to a widely discrepant epidemiology that applies to both ‘sepsis’ and ‘septic shock’. …