title: AME evidence series 001-The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital.
abstract: Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for clinical use of different diagnostic tools rely on the Grades of Recommendation Assessment, Development and Evaluation (GRADE) framework. Because most of the studies were observational and did not allow a reliable assessment of these tools, a two-step inference approach was employed. Future trials need to confirm or refute a particular index test and should directly explore relevant patient outcome parameters.
authors.affiliation: Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;; Department of Critical Care Medicine, Jinhua Hospital of Zhejiang University, Jinhua 321000, China.
authors.forename: Zhongheng
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Smischney
authors.affiliation: Keenan Research Center for Biomedical Science of St. Michael's Hospital, Departments of Anesthesia and Physiology, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Departments of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Sven
authors.initials: S
authors.lastname: Van Poucke
authors.affiliation: 2nd Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsirigotis
authors.affiliation: CIBERES, Vall d'Hebron Institut of Research, Universitat Autonoma de Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rello
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Honore
authors.affiliation: Emergency Medicine Department, National University Hospital, National University Health System, Singapore and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Win
authors.initials: W
authors.lastname: Sen Kuan
authors.affiliation: DeWitt Daughtry Family Department of Surgery, Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
authors.forename: Juliet June
authors.initials: JJ
authors.lastname: Ray
authors.affiliation: Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
authors.forename: Jiancang
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Critical Care Medicine, Union Hospital, Tongji Medical Collegue, Huazhong University of Science and Technology, Wuhan 430022, China.
authors.forename: You
authors.initials: Y
authors.lastname: Shang
authors.affiliation: Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
authors.forename: Yuetian
authors.initials: Y
authors.lastname: Yu
authors.affiliation: University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Jung
authors.affiliation: Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Chiara
authors.initials: C
authors.lastname: Robba
authors.affiliation: Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.affiliation: Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Caironi
authors.affiliation: Intensive Care Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: David
authors.initials: D
authors.lastname: Grimaldi
authors.affiliation: Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hofer
authors.affiliation: Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
authors.affiliation: Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang-Bum
authors.initials: SB
authors.lastname: Hong
authors.affiliation: Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.affiliation: Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.affiliation: Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Won Young
authors.initials: WY
authors.lastname: Kim
authors.affiliation: Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium.
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Spapen
authors.affiliation: Department of Internal Medicine and Post-graduated Program, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Jose Rodolfo
authors.initials: JR
authors.lastname: Rocco
keywords: Sepsis; diagnosis; early identification