Rahul Kashyap1, Tarun D Singh2, Hamza Rayes3, John C O'Horo4, Gregory Wilson5, Philippe Bauer3, Ognjen Gajic3. 1. Department of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States; Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, United States. Electronic address: kashyap.rahul@mayo.edu. 2. Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Department of Neurology and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States. 3. Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States. 4. Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States; Division of Infectious Disease, Mayo Clinic, Rochester, MN, United States. 5. Multidisciplinary Epidemiology and Translational Research in Intensive Care- METRIC, Mayo Clinic, Rochester, MN, United States; Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, United States.
Abstract
PURPOSE: The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically ill patients. MATERIAL AND METHODS: Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality. RESULTS: The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54-75) years and 4167(55.8%) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57-92) vs. 70 (56-89), p < .01); SOFA score; (6 (4-10) vs. 6 (4-9), p < .01), were older (70 (59-79) vs. 64 (54-74) years, p = .03). They also had higher hospital mortality, N (%) 71, (19.7%) vs. 40 (12.6%), p < .01) and a higher SMR (0.66 vs. 0.45, p < .01). CONCLUSIONS: Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.
PURPOSE: The newly proposed septic shock definition has provoked a substantial controversy in the emergency and critical care communities. We aim to compare new (SEPSIS-III) versus old (SEPSIS-II) definitions for septic shock in a contemporary cohort of critically illpatients. MATERIAL AND METHODS: Retrospective cohort of consecutive patients, age ≥ 18 years admitted to intensive care units at the Mayo Clinic between January 2009 and October 2015. We compared patients who met old, new, both, or neither definition of sepsis shock. SMR were calculated using APACHE IV predicted mortality. RESULTS: The initial cohort consisted of 16,720 patients who had suspicion of infection, 7463 required vasopressor support. The median (IQR) age was 65(54-75) years and 4167(55.8%) were male. Compared to patients with old definition, the patients with new definition had higher APACHE III score (median IQR); (73 (57-92) vs. 70 (56-89), p < .01); SOFA score; (6 (4-10) vs. 6 (4-9), p < .01), were older (70 (59-79) vs. 64 (54-74) years, p = .03). They also had higher hospital mortality, N (%) 71, (19.7%) vs. 40 (12.6%), p < .01) and a higher SMR (0.66 vs. 0.45, p < .01). CONCLUSIONS: Compared to SEPSIS-II, SEPSIS-III definition of septic shock identifies patients further along disease trajectory with higher likelihood of poor outcome.
Authors: Vikas Bansal; Nathan J Smischney; Rahul Kashyap; Zhuo Li; Alberto Marquez; Daniel A Diedrich; Jason L Siegel; Ayan Sen; Amanda D Tomlinson; Carla P Venegas-Borsellino; William David Freeman Journal: Front Med (Lausanne) Date: 2022-02-17