The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
复制标题
脓毒症与脓毒性休克的第三版国际共识定义（脓毒症3.0）
DOI：
10.1001/jama.2016.0287
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发表时间：
2016-02-23
影响因子：
120.7
通讯作者：
Angus, Derek C.
中科院分区：
文献类型：
--
作者：
Singer, Mervyn;Deutschman, Clifford S.;Angus, Derek C.
脓毒症和脓毒性休克的定义最近一次修订是在2001年。从那时起，病理学已经取得了相当大的进展，（器官功能、形态学、细胞生物学、生物化学、免疫学和循环的变化）、管理和脓毒症的流行病学，提示需要重新检查。和流行病学是由重症监护医学协会和欧洲重症监护医学协会召集的。定义和临床标准通过会议、德尔菲程序、电子健康记录数据库分析和投票产生，然后分发给国际专业协会，要求同行评审和认可（鸣谢中列出的31个学会）。证据综合的关键发现以前定义的局限性包括过度关注炎症，脓毒症遵循从严重脓毒症到休克的连续体的误导模型，以及全身炎症反应综合征（SIRS）标准的特异性和敏感性不足。脓毒症、脓毒性休克和器官功能障碍目前使用多种定义和术语，导致报告的发病率和观察到的死亡率存在差异。特别工作组的结论是严重脓毒症这个术语是多余的。建议脓毒症应该被定义为由宿主对感染的反应失调引起的危及生命的器官功能障碍。对于临床操作，器官功能障碍可以通过序贯[脓毒症相关]器官衰竭评估（SOFA）评分增加2分或更多来表示，这与大于10%的住院死亡率相关。脓毒性休克应被定义为脓毒症的一个亚类，其中特别严重的循环、细胞和代谢异常与比单独脓毒症更大的死亡风险相关。感染性休克患者在临床上可以通过血管加压药需求来确定，以维持平均动脉压为65 mmHg或更高，血清乳酸水平大于2 mmol/L（> 18 mg/dL），而不存在低血容量。这种组合与医院死亡率超过40%相关。在院外、急诊科或综合医院病房环境中，如果疑似感染的成人患者具有以下至少2项临床标准，则可以快速确定其更可能具有脓毒症典型的不良结局，这些临床标准共同构成称为quickSOFA（qSOFA）的新床旁临床评分：呼吸频率22/min或更高，精神状态改变，或收缩压100 mmHg或更低。结论和相关性这些更新的定义和临床标准应该取代以前的定义，为流行病学研究和临床试验提供更大的一致性，并促进对脓毒症患者或有发生脓毒症风险的患者的早期识别和更及时的管理。
IMPORTANCE Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination.OBJECTIVE To evaluate and, as needed, update definitions for sepsis and septic shock.PROCESS A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine. Definitions and clinical criteria were generated through meetings, Delphi processes, analysis of electronic health record databases, and voting, followed by circulation to international professional societies, requesting peer review and endorsement (by 31 societies listed in the Acknowledgment).KEY FINDINGS FROMEVIDENCE SYNTHESIS Limitations of previous definitions included an excessive focus on inflammation, the misleading model that sepsis follows a continuum through severe sepsis to shock, and inadequate specificity and sensitivity of the systemic inflammatory response syndrome (SIRS) criteria. Multiple definitions and terminologies are currently in use for sepsis, septic shock, and organ dysfunction, leading to discrepancies in reported incidence and observed mortality. The task force concluded the term severe sepsis was redundant.RECOMMENDATIONS Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Septic shock should be defined 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 65mmHg or greater and serum lactate level greater than 2 mmol/L (> 18mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100mmHg or less.CONCLUSIONS AND RELEVANCE These updated definitions and clinical criteria should replace previous definitions, offer greater consistency for epidemiologic studies and clinical trials, and facilitate earlier recognition and more timely management of patients with sepsis or at risk of developing sepsis.