Do Sepsis-3 criteria facilitate earlier recognition of sepsis and septic shock? A retrospective cohort study

Background: New Sepsis-3 criteria are supposed to “facilitate earlier recognition…of patients with sepsis”. To test this, we performed novel and direct comparisons of Sepsis-1 vs. Sepsis-3 criteria with respect to time differences of sepsis onset. Methods: In a cohort of intensive care unit (ICU) patients prospectively diagnosed with severe sepsis or septic shock according to Sepsis-1 criteria between 01/2010–12/2015 the time differences between meeting Sepsis-1 vs. Sepsis-3 criteria as time of sepsis onset and the corresponding differences in illness severity were tested. Similar comparisons were performed for septic shock subset meeting different Sepsis-1 vs. Sepsis-3 criteria. Patients with non-ICU acquired sepsis and patients with sepsis onset > 48 h post admission (ICU acquired sepsis) were analyzed separately to account for differences in availability of routinely collected organ dysfunction data. Results: 10905 ICU patients were screened. 862 patients met Sepsis-1 criteria, of whom 834 (97%) also met Sepsis-3 criteria. In patients, admitted to the ICU with sepsis, Sepsis-3 criteria compared to Sepsis-1 criteria were more frequently fulfilled within the first 3 hours (84% vs. 75%, P 0.05). Patients not detected by Sepsis-3 had a 28-day mortality of 11%. Conclusions: Sepsis-3 criteria facilitate an earlier and more predictive recognition of sepsis and septic shock in patients with non-ICU and ICU acquired sepsis primarily diagnosed by Sepsis-1 criteria. These results require further validation with prospectively collected data. Address reprint requests to Christian S. Scheer, Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, University Hospital of Greifswald, Germany, Ferdinand-Sauerbruch Straße, 17475 Greifswald, Germany. E-mail: christian.scheer@uni-greifswald.de Received 19 March, 2018 Revised 4 April, 2018 Accepted 2 May, 2018 Christian S. Scheer and Sven-Olaf Kuhn contributed equally. Conflict of interest disclosures: Dr. Scheer reported travel reimbursement and conference expenses from Astellas Pharma and lecture fees from Radiometer and Accelerate Diagnostics. Dr. Kuhn reports personal fees from Dräger medical Germany, Lilly medical and grants from Federal Ministry of Education and research (BMBF) Germany. Christian Fuchs received travel fees for the DIVI congress 2015 from Astellas Pharma GmbH. Dr. Gründling reports grants from Federal Ministry of Education and Research (BMBF), Germany, personal fees and non-financial support from Dräger Medical Germany, Pfizer Deutschland GmbH and Becton, Dickinson and Company. Dr. Rehberg reported receiving travel reimbursement from Orion and Astellas, grant support from Fresenius Kabi Germany and fees from Amomed Pharma. All other authors declare no conflicts of interest. Authors contributions: Christian S. Scheer, Sven-Olaf Kuhn and Marcus Vollmer performed the data analysis. All authors contributed to the data interpretation. Christian S. Scheer, Sven-Olaf Kuhn, Matthias Gründling and Sebastian Rehberg drafted the first version of the manuscript. Frank Brunkhorst and Manu Shankar-Hari contributed to the methodical approach and the data interpretation. All authors amended and approved the final version of the manuscript. Sven-Olaf Kuhn, Christian S. Scheer and Marcus Vollmer have full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis, including and especially any adverse effects. Christian S. Scheer and Sven-Olaf Kuhn assume full responsibility for the integrity of the submission as a whole, from inception to published article. Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.shockjournal.com). © 2018 by the Shock Societ