How many general and inflammatory variables need to be fulfilled when defining sepsis due to the 2003 SCCM/ESICM/ACCP/ATS/SIS definitions in critically ill surgical patients: a retrospective observational study

摘要

Background It has never been specified how many of the extended general and inflammatory variables of the 2003 SCCM/ESICM/ACCP/ATS/SIS consensus sepsis definitions are mandatory to define sepsis. Objectives To find out how many of these variables are needed to identify almost all patients with septic shock. Methods Retrospective observational single-centre study in postoperative/posttraumatic patients admitted to an University adult ICU. The survey looked at 1355 admissions, from 01/2007 to 12/2008, that were monitored daily computer-assisted for the eight general and inflammatory variables temperature, heart rate, respiratory rate, significant edema, positive fluid balance, hyperglycemia, white blood cell count and C-reactive protein. A total of 507 patients with infections were classified based on the first day with the highest diagnostic category of sepsis during their stay using a cut-off of 1/8 variables compared with the corresponding classification based on a cut-off of 2, 3, 4, 5, 6, 7 or 8/8 variables. Results Applying cut-offs of 1/8 up to 8/8 variables resulted in a decreased detection rate of cases with septic shock, i.e., from 106, 105, 103, 93, 65, 21, 3 to 0. The mortality rate increased up to a cut-off of 6/8 variables, i.e., 31% (33/106), 31% (33/105), 31% (32/103), 32% (30/93), 38% (25/65), 43% (9/21), 33% (1/3) and 0% (0/0). Conclusions Frequencies and mortality rates of diagnostic categories of sepsis differ depending on the cut-off for general and inflammatory variables. A cut-off of 3/8 variables is needed to identify almost all patients with septic shock who may benefit from optimal treatment.