Robustness of sepsis-3 criteria in critically ill patients

Table 1 Sepsis definitions

Old sepsis
MARS-sepsis	Presence of ≥ 2 SIRS criteria and organ failure within a 4-day window around suspected infection^{a, b}
MARS-septic shock	MARS-sepsis and use of vasopressor for hypotension within a 4-day window^{a, c}
Sepsis-3
Sepsis-3 (4-day window)	Suspected infection and an acute SOFA score increase of ≥ 2 points within a 4-day window ^a
Septic shock-3	Sepsis-3 and vasopressor-dependent hypotension (i.e., circulatory SOFA score ≥ 2) plus an increased serum lactate level of > 2 mmol/L within a 4-day window ^{a, d}
Assessments of minor variations in diagnostic criteria
Reduced observation window	Similar to sepsis-3, but with a 2-day window around suspected infection (i.e., an increase between the day before and the day of the onset of infection)
Absolute SOFA score	Suspected infection and an absolute SOFA score of ≥ 2 points at the day of onset of infection and within a 4-day window^a
Septic shock-3 ignoring lactate	Similar to septic shock-3, but without the requirement of increased serum lactate levels if not measured

SIRS = Systemic Inflammatory Response Syndrome, SOFA = Sequential Organ Failure Assessment
^a 4-day window = an observation window ranging from 2 days before the initiation of empirical antibiotics (onset of infection) until 1 day after the onset of infection
^b Organ failure for MARS-sepsis was defined as the following signs of organ hypoperfusion or dysfunction: areas of mottled skin; capillary refilling requiring 3 s or longer; urine output < 0.5 ml/kg for at least 6 h, > 1.5-fold elevated creatinine or renal replacement therapy; lactate > 2 mmol/l; abrupt change in mental status; abnormal electroencephalographic findings consistent with septic encephalopathy; platelet count < 100,000 platelets/ml or disseminated intravascular coagulation; acute respiratory distress syndrome and cardiac dysfunction, as defined by echocardiography or direct measurement of the cardiac index [22]”
^cMARS-septic shock was defined as the use of norepinephrine in a dose of > 100 ng/kg/min for more than 50% of an observation day, dopamine > 5 mcg/kg/min or epinephrine for hypotension despite adequate fluid resuscitation (e.g., not including induced hypertension)
^dLactate was considered increased if it was increased once at any day during the 4-day time window

ISSN: 2052-0492