Verboom Diana M, Frencken Jos F, Ong David S Y, Horn Janneke, van der Poll Tom, Bonten Marc J M, Cremer Olaf L, Klein Klouwenberg Peter M C
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
J Intensive Care. 2019 Aug 29;7:46. doi: 10.1186/s40560-019-0400-6. eCollection 2019.
Early recognition of sepsis is challenging, and diagnostic criteria have changed repeatedly. We assessed the robustness of sepsis-3 criteria in intensive care unit (ICU) patients.
We studied the apparent incidence and associated mortality of sepsis-3 among patients who were prospectively enrolled in the Molecular Diagnosis and Risk Stratification of Sepsis (MARS) cohort in the Netherlands, and explored the effects of minor variations in the precise definition and timing of diagnostic criteria for organ failure.
Among 1081 patients with suspected infection upon ICU admission, 648 (60%) were considered to have sepsis according to prospective adjudication in the MARS study, whereas 976 (90%) met sepsis-3 criteria, yielding only 64% agreement at the individual patient level. Among 501 subjects developing ICU-acquired infection, these rates were 270 (54%) and 260 (52%), respectively (yielding 58% agreement). Hospital mortality was 234 (36%) vs 277 (28%) for those meeting MARS-sepsis or sepsis-3 criteria upon presentation ( < 0.001), and 121 (45%) vs 103 (40%) for those having sepsis onset in the ICU ( < 0.001). Minor variations in timing and interpretation of organ failure criteria had a considerable effect on the apparent prevalence of sepsis-3, which ranged from 68 to 96% among those with infection at admission, and from 22 to 99% among ICU-acquired cases.
The sepsis-3 definition lacks robustness as well as discriminatory ability, since nearly all patients presenting to ICU with suspected infection fulfill its criteria. These should therefore be specified in greater detail, and applied more consistently, during future sepsis studies.
The MARS study is registered at ClinicalTrials.gov (identifier NCT01905033).
脓毒症的早期识别具有挑战性，诊断标准也反复变化。我们评估了脓毒症-3标准在重症监护病房（ICU）患者中的稳健性。
我们研究了前瞻性纳入荷兰脓毒症分子诊断与风险分层（MARS）队列的患者中脓毒症-3的表观发病率及相关死亡率，并探讨了器官功能衰竭诊断标准在精确界定和时间方面的微小差异所产生的影响。
在1081例入住ICU时疑似感染的患者中，根据MARS研究的前瞻性判定，648例（60%）被认为患有脓毒症，而976例（90%）符合脓毒症-3标准，在个体患者层面仅产生64%的一致性。在501例发生ICU获得性感染的患者中，这些比例分别为270例（54%）和260例（52%）（一致性为58%）。对于入院时符合MARS脓毒症或脓毒症-3标准的患者，医院死亡率分别为234例（36%）和277例（28%）（P<0.001），对于在ICU发生脓毒症的患者，死亡率分别为121例（45%）和103例（40%）（P<0.001）。器官功能衰竭标准在时间和解读方面的微小差异对脓毒症-3的表观患病率有相当大的影响，在入院时感染的患者中，该患病率范围为68%至96%，在ICU获得性病例中为22%至99%。
脓毒症-3的定义缺乏稳健性和鉴别能力，因为几乎所有入住ICU时疑似感染的患者都符合其标准。因此，在未来的脓毒症研究中，这些标准应更详细地明确，并更一致地应用。
MARS研究已在ClinicalTrials.gov注册（标识符NCT01905033）。
