Different patient case mix by applying the 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions instead of the 1992 ACCP/SCCM sepsis definitions in surgical patients: a retrospective observational study.
BACKGROUND
Revised consensus sepsis definitions have been published in 2003. The present study was performed to compare the prevalence of different stages of sepsis and ICU mortality rates and find out the case mix within the same collective of postoperative/posttraumatic patients applying either the original 1992 ACCP/SCCM or the revised 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions.


METHODS
Retrospective observational single-centre study in surgical critically ill patients admitted to an University adult ICU. From 01/2007 to 12/2007, 742 patients were surveyed daily computer-assisted with respect to different stages of sepsis.


RESULTS
Within the same patient collective, applying the 2003 definitions instead of the 1992 definitions, prevalence of severe sepsis (61 vs. 56) and septic shock (205 vs. 162) was higher (p < 0.001). In patients with septic shock according to the 2003 definitions, mortality rate of 22% was lower than that of 27%, when the 1992 definitions were used. Risk of death was increased for those patients classified to be in septic shock with any of the definitions (OR 6.5, p = 0.001). Sensitivity to predict deaths was slightly higher with the 2003 definitions (92%) than with the 1992 definitions (88%), and specificity was lower (31% vs. 49%).


CONCLUSIONS
The prevalence and mortality rates of various sepsis severity stages differ if defined by the 1992 or the 2003 definitions. Thus, transferring conclusions drawn from data sets regarding severity of sepsis generated with the 1992 definitions to the same population applying the 2003 definitions may be misleading. The 1992 definitions may under-classify patients with severe sepsis.
Weiss
Manfred
M
Department of Anaesthesiology, University Hospital Ulm, Steinhoevelstrasse 9, Ulm, Germany. manfred.weiss@uniklinik-ulm.de
Huber-Lang
Markus
M
Taenzer
Michael
M
Traeger
Karl
K
Altherr
Juergen
J
Kron
Martina
M
Hay
Birgit
B
Schneider
Marion
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003245:Consensus Statements as Topic; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000145:classification / Q000175:diagnosis / Q000401:mortality; D011183:Postoperative Complications / Q000145:classification / Q000175:diagnosis*; D012189:Retrospective Studies; D018805:Sepsis / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D012772:Shock, Septic / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D012955:Societies, Medical; D018746:Systemic Inflammatory Response Syndrome / Q000145:classification / Q000175:diagnosis* / Q000401:mortality; D009626:Terminology as Topic; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery; D055815:Young Adult