title: Judging quality of current septic shock definitions and criteria.
abstract: Septic shock definitions are being revisited. We assess the feasibility, reliability, and validity characteristics of the current definitions and criteria of septic shock. Septic shock is conceptualised as cardiovascular dysfunction, tissue perfusion and cellular abnormalities caused by infection. Currently, for feasibility, septic shock is identified at the bedside by using either hypotension or a proxy for tissue perfusion/cellular abnormalities (e.g., hyperlactatemia). We propose that concurrent presence of cardiovascular dysfunction and perfusion/cellular abnormalities could improve validity of septic shock diagnosis, as we are more likely to identify a patient population with all elements of the illness concept. This epidemiological refinement should not affect clinical care and may aid study design to identify illness-specific biomarkers and interventions.
authors.affiliation: Department of Intensive Care Medicine, 1st Floor, East Wing, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK. manu.shankar-hari@kcl.ac.uk.|Division of Asthma, Allergy and Lung Biology, King's College London, ᅟ, SE1 9RT, UK. manu.shankar-hari@kcl.ac.uk.
authors.forename: Manu
authors.initials: M
authors.lastname: Shankar-Hari
authors.affiliation: Laboratory of Clinical Epidemiology and GiViTI Coordinating Centre, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Villa Camozzi, 24020, Ranica (Bergamo), Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Bertolini
authors.affiliation: Paul-Martini-Research Group for Clinical Sepsis Research, Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 29, Jena, 07737, Germany.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Brunkhorst
authors.affiliation: Department of Intensive Care and Medicine, Austin Health, Heidelberg, Melbourne, VIC, 3084, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Department of Intensive Care Medicine, Hôpital Raymond Poincaré (AP-HP), Laboratory of Cell Death, Inflammation & Infection, UMR1173 University of Versailles SQY & INSERM, 92380, Garches, France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.affiliation: Departments of Pediatrics and Molecular Medicine, Hofstra-North Shore-Long Island Jewish-Hofstra School of Medicine, New Hyde Park, NY, 11040, USA.|Feinstein Institute for Medical Research, Manhasset, NY, 11030, USA.
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Deutschman
authors.affiliation: Bloomsbury Institute of Intensive Care Medicine, University College London, London, WC1E 6BT, UK.
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
mesh_terms: D015415:Biomarkers / Q000097:blood; D006801:Humans; D038801:International Classification of Diseases; D019344:Lactic Acid / Q000009:adverse effects / Q000032:analysis / Q000097:blood; D011379:Prognosis; D015203:Reproducibility of Results; D012772:Shock, Septic / Q000097:blood / Q000145:classification* / Q000175:diagnosis* / Q000473:pathology; D009626:Terminology as Topic
chemical_list: D015415:Biomarkers; D019344:Lactic Acid