Identifying Patients With Sepsis on the Hospital Wards

Abstract

Sepsis contributes to up to half of all deaths in hospitalized patients, and early interventions, such as appropriate antibiotics, have been shown to improve outcomes. Most research has focused on early identification and treatment of patients with sepsis in the ED and the ICU; however, many patients acquire sepsis on the general wards. The goal of this review is to discuss recent advances in the detection of sepsis in patients on the hospital wards. We discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening patients with sepsis, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick sepsis-related organ failure assessment (qSOFA) score. Challenges specific to detecting sepsis on the wards are discussed, and future directions that use big data approaches and automated alert systems are highlighted.

The new sepsis consensus definitions (Sepsis-3): the good, the not-so-bad, and the actually-quite-pretty

“…Claimed improvements in outcome [12] are actually based on data from patients with existing organ dysfunction, who likely have the ≥2 SOFA point rise to describe 'new' sepsis. This blank ammunition does not support the arguments of Sprung et al about early recognition and treatment before organ dysfunction has developed, nor does the lack of outcome benefit from the SIRS screening studies [6].…”

“…Its components remain useful when considering infection but less so for identifying the sick septic patient. Outcome benefit from manual or automated SIRS-based screening tools is unproved [6]; despite increasing delivery of management bundles, rates of ICU transfer and mortality are unaltered. High rates of false positives and alert fatigue are also commonplace.…”

Sepsis associated acute kidney injury

“…Finally, an effort is ongoing to take a step back from biochemical measures such as NGAL or TIMP2*IGFBP7 and use real time data from the electronic health record to identify patients with either sepsis or AKI, and we anticipate that automated alerts for these patients will be combined with biochemical biomarker testing to improve risk stratification and case detection for SA-AKI. We anticipate that electronic risk score and biochemical biomarkers will be incorporated into standard of care over the next decade 828384…”

Integrating molecular pathogenesis and clinical translation in sepsis-induced acute respiratory distress syndrome

“…Patients with septic shock had significantly higher mortality than those with sepsis alone (>40% vs. >10%). Importantly, aspects of this definition are still undergoing critical evaluation (4)(5)(6)(7)(8)(9). ARDS is defined by the acute (less than 7 days) onset of hypoxemia and bilateral radiographic infiltrates consistent with pulmonary edema that are not explained by heart failure (10).…”