title: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  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.
  
  
  CONCLUSIONS
  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 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/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 100 mm Hg or less.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom.
authors.forename: Mervyn
authors.initials: M
authors.lastname: Singer
authors.affiliation: Hofstra-Northwell School of Medicine, Feinstein Institute for Medical Research, New Hyde Park, New York.
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Deutschman
authors.affiliation: Department of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Christopher Warren
authors.initials: CW
authors.lastname: Seymour
authors.affiliation: Department of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
authors.forename: Manu
authors.initials: M
authors.lastname: Shankar-Hari
authors.affiliation: Department of Critical Care Medicine, University of Versailles, France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.affiliation: Center for Sepsis Control and Care, University Hospital, Jena, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, and Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.affiliation: Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University, Nashville, Tennessee.
authors.forename: Gordon R
authors.initials: GR
authors.lastname: Bernard
authors.affiliation: Réanimation Médicale-Hôpital Cochin, Descartes University, Cochin Institute, Paris, France.
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.affiliation: Critical Care Center, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Coopersmith
authors.affiliation: Washington University School of Medicine, St Louis, Missouri.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hotchkiss
authors.affiliation: Infectious Disease Section, Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, Rhode Island.
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Levy
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.affiliation: Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
authors.affiliation: Infectious Disease Section, Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, Rhode Island.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Opal
authors.affiliation: Trauma, Emergency & Critical Care Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada16Interdepartmental Division of Critical Care, University of Toronto.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Rubenfeld
authors.affiliation: Department of Infectious Diseases, Academisch Medisch Centrum, Amsterdam, the Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: van der Poll
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Brussels, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh and UPMC Health System, Pittsburgh, Pennsylvania20Associate Editor, JAMA.
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
mesh_terms: D026683:Advisory Committees / Q000458:organization & administration; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D003697:Delphi Technique; D017052:Hospital Mortality; D006801:Humans; D038801:International Classification of Diseases; D007773:Lactates / Q000097:blood; D063305:Organ Dysfunction Scores; D017712:Peer Review, Research; D056152:Respiratory Rate; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D012772:Shock, Septic / Q000097:blood / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis; D009626:Terminology as Topic; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D007773:Lactates; D014662:Vasoconstrictor Agents