Sepse

See JAMA 317:3, p267-7

Seit Beginn des Jahres gibt es neben dem Sofa Score noch den sogenannten qSOFA welcher eine noch einfachere Handhabung in klinischen Alltag garantieren soll.
VG

Score zur Sepsis-Diagnose (Kurzversion des SOFA-Scores)

http://jama.jamanetwork.com/data/Journals/JAMA/935012/jsc160002.pdf

Identificación de Sepsis

Nuevo score para Sepsis

GCS of 13 or less
Systolic blood pressure of 100 mgHg or less
Respiratory rate of 22 or more

One point for each category range 0-3

Assessment of Clinical Criteria for Sepsis
For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
JAMA February 23, 2016 Volume 315, Number 8

Nuca fórmula para evaluar Sepsis o riesgo de Sepsis fuera de la UCI qSOFA

New quick SOFA calculation that just was reported for quick assessment of sepsis risk.

The quick sofa sepsis score. 2/23/16 Jama says it is superior for non-icu sepsis prediction.

Given breaking news - updated SOFA and qSOFA need to be in formula.

New definitions of sepsis and septic shock, replacing the 2001 criteria, were released this week by an international task force.

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) were published in the Feb. 23 Journal of the American Medical Association, along with a systematic review and study on which they were based. The definitions were developed by a task force convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine and were endorsed by a number of other societies.

The new consensus defines sepsis as "life-threatening organ dysfunction caused by a dysregulated host response to infection." Clinically, this means an increase in the Sequential [Sepsis-Related] Organ Failure Assessment (SOFA) score of 2 points or more, the document said. The study supporting this definition looked at records for 148,907 patients with suspected infection. It found that the SOFA's predictive validity for inpatient mortality of ICU patients was statistically greater than that of the systemic inflammatory response syndrome (SIRS) criteria and was not significantly different from that of the Logistic Organ Dysfunction System (LODS) score, which was noted to be more complex.

The task force also developed a new bedside clinical score called quickSOFA (qSOFA) with 3 components: respiratory rate of 22 breaths/min or greater, altered mentation, and systolic blood pressure of 100 mm Hg or less. Patients who met at least 2 of these criteria had significantly higher mortality risk, the study found. It determined that, for predicting inpatient mortality, SOFA had better validity than qSOFA in ICU patients, but the reverse was true in non-ICU patients with suspected infection. Thus, the qSOFA score can be used outside of the ICU to identify patients more likely to have poor outcomes, the consensus authors said.

The consensus defined 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." Clinically, septic shock can be identified as a requirement for vasopressors to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate greater than 2 mmol/L in the absence of hypovolemia (i.e., after adequate fluid resuscitation). This definition was based on a systematic review of 44 studies reporting septic shock outcomes.

The new definitions are likely to generate debate and discussion, said the consensus authors, noting the absence of "simple or unambiguous clinical criteria or biological, imaging, or laboratory features" of sepsis. They described the definitions as a work in progress and stressed that SIRS could continue to be useful for the identification of infection and that neither qSOFA nor SOFA should be considered a stand-alone definition of sepsis.

An accompanying editorial called for qSOFA to be validated before it enters routine practice. "Although the new definitions provide a broad view of the universe of sepsis and may help in facilitating early identification of patients with this condition, they will be of only limited help in directing specific therapies to individual patients or in designing clinical trials focused on specific mechanisms of sepsis-induced organ dysfunction," the editorial said.