News: International task force releases new sepsis definition
The Third International Consensus Definitions Task Force updated the standards of sepsis and septic shock, including simplified clinical criteria for rapid recognition of sepsis-related organ failure and new criteria for septic shock, according to an article published February 23 in the Journal of the American Medical Association (JAMA).
The new definitions were developed based on analysis of more than 800,000 encounters at 177 hospitals worldwide.
The new criteria defines sepsis as evidence of infection plus life-threatening organ dysfunction, clinically characterized by an acute change of two points or greater in the Sepsis-Related Organ Failure Assessment (SOFA) score, which is associated with an in-hospital mortality greater than 10%.
The task force defines septic shock as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia, JAMA says.
Quick SOFA (qSOFA) is a bedside clinical approach used to identify patients who are likely to have a prolonged ICU stay or die in the hospital, but it does not substitute for SOFA for defining organ dysfunction. The qSOFA score will be used to assess three symptoms in patients with suspected sepsis:
- altered mental status
- fast respiratory rate
- low blood pressure
Blood tests are not required. If patients show two of the three criteria, they should be considered likely to be septic, says JAMA.
The task force unanimously considered the previous requirement for two or more systemic inflammatory response syndrome (SIRS) criteria to be unhelpful in the diagnosis of sepsis. Recent studies have shown that SIRS symptoms can occur in a large majority of hospitalized patients and are often associated with benign conditions.
"The SIRS criteria do not necessarily indicate a dysregulated, life-threatening response," the task force wrote. "SIRS criteria are present in many hospitalized patients, including those who never develop infection and never incur adverse outcomes."
CDI professionals need to be aware that the code set definitions of sepsis and severe sepsis remain the same, and are different from the task force’s criteria, says Laurie Prescott, RN- MSN, CCDS, CDIP, CDI Education Director for HCPro in Danvers, Massachusetts.
However, because physicians and some payers may use the new definitions, there may be denials based on the new criteria. If faced with a denial, Prescott says CDI professionals must know the difference between the new clinical criteria and the current code set criteria. The new criteria may influence changes in the code set later on, but it currently does not.