Intensive Care Medicine

, Volume 29, Issue 4, pp 530–538 | Cite as

2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference

  • Mitchell M. Levy
  • Mitchell P. Fink
  • John C. Marshall
  • Edward Abraham
  • Derek Angus
  • Deborah Cook
  • Jonathan Cohen
  • Steven M. Opal
  • Jean-Louis Vincent
  • Graham Ramsay
  • for the International Sepsis Definitions Conference
Expert Panel

Abstract

Objective

In 1991, the American College of Chest Physicians (ACCP) and the Society of Critical Care Medicine (SCCM) convened a "Consensus Conference," the goals of which were to "provide a conceptual and a practical framework to define the systemic inflammatory response to infection, which is a progressive injurious process that falls under the generalized term 'sepsis' and includes sepsis-associated organ dysfunction as well. The general definitions introduced as a result of that conference have been widely used in practice, and have served as the foundation for inclusion criteria for numerous clinical trials of therapeutic interventions. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes.

Design

Several North American and European intensive care societies agreed to revisit the definitions for sepsis and related conditions. This conference was sponsored by the Society of Critical Care Medicine (SCCM), The European Society of Intensive Care Medicine (ESICM), The American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Surgical Infection Society (SIS).

Methods

29 participants attended the conference from Europe and North America. In advance of the conference, subgroups were formed to evaluate the following areas: signs and symptoms of sepsis, cell markers, cytokines, microbiologic data, and coagulation parameters.. The present manuscript serves as the final report of the 2001 International Sepsis Definitions Conference.

Conclusion

1. Current concepts of sepsis, severe sepsis and septic shock remain useful to clinicians and researchers. 2. These definitions do not allow precise staging or prognostication of the host response to infection. 3. While SIRS remains a useful concept, the diagnostic criteria for SIRS published in 1992 are overly sensitive and non-specific. 4. An expanded list of signs and symptoms of sepsis may better reflect the clinical response to infection. 6. PIRO, a hypothetical model for staging sepsis is presented, which, in the future, may better characterize the syndrome on the basis of predisposing factors and premorbid conditions, the nature of the underlying infection, the characteristics of the host response, and the extent of the resultant organ dysfunction.

Keywords

Sepsis Severe Sepsis Septic Shock SIRS PIRO 

References

  1. 1.
    Members of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874PubMedGoogle Scholar
  2. 2.
    Marshall JC (2000) SIRS and MODS: what is their relevance to the science and practice of intensive care? Shock 14:586–589PubMedGoogle Scholar
  3. 3.
    Vincent J-L (1997) Dear SIRS, I'm sorry to say that I don't like you. Crit Care Med 25:372–374Google Scholar
  4. 4.
    Ramsay G, Gerlach H, Levy MM, et al (2003) An international sepsis survey: a study of doctors' knowledge and perception about sepsis. Crit Care Med 2003 (in press)Google Scholar
  5. 5.
    Joint International Society and Federation of Cardiology/World Health Organization Task Force on Standardization of Clinical Nomenclature (1979) Nomenclature and criteria for diagnosis of ischemic heart disease. Circulation 59:607–609PubMedGoogle Scholar
  6. 6.
    Falahati A, Sharkey SW, Christensen D, et al (1999) Implementation of serum cardiac troponin I as marker for detection of acute myocardial infarction. Am Heart J 137:332–337PubMedGoogle Scholar
  7. 7.
    Antman EM, Grudzien C, Mitchell RN, et al (2002) Detection of unsuspected myocardial necrosis by rapid bedside assay for cardiac troponin T. Am Heart J 133:596–598Google Scholar
  8. 8.
    Puleo PR, Meyer D, Wathen C, et al (2002) Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction. N Engl J Med 331:561–566CrossRefGoogle Scholar
  9. 9.
    Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction (2000) Myocardial infarction redefined–-a consensus document. J Am Coll Cardiol 36:959–969PubMedGoogle Scholar
  10. 10.
    Taniguchi T, Koido Y, Aiboshi J, et al (1999) Change in the ratio of interleukin-6 to interleukin-10 predicts a poor outcome in patients with systemic inflammatory response syndrome. Crit Care Med 27:1262–1264PubMedGoogle Scholar
  11. 11.
    Ueda S, Nishio K, Minamino N, et al (1999) Increased plasma levels of adrenomedullin in patients with systemic inflammatory response syndrome. Am J Respir Crit Care Med 160:132–136PubMedGoogle Scholar
  12. 12.
    Stoiser B, Knapp S, Thalhammer F, et al (1998) Time course of immunological markers in patients with the systemic inflammatory response syndrome: evaluation of sCD14, sVCAM-1, sELAM-1, MIP-1 alpha and TGF-beta 2. Eur J Clin Invest 28:672–678CrossRefPubMedGoogle Scholar
  13. 13.
    Hietaranta A, Kemppainen E, Puolakkainen P, et al (2002) Extracellular phospholipases A2 in relation to systemic inflammatory response syndrome (SIRS) and systemic complications in severe acute pancreatitis. Pancreas 18:385–391Google Scholar
  14. 14.
    Takala A, Jousela I, Olkkola KT, et al (1999) Systemic inflammatory response syndrome without systemic inflammation in acutely ill patients admitted to hospital in a medical emergency. Clin Sci (Colch) 96:287–295Google Scholar
  15. 15.
    Sablotzki A, Borgermann J, Baulig W, Friedrich I, Spillner J, Silber RE, Czeslick E (2001) Lipopolysaccharide-binding protein (LBP) and markers of acute-phase response in patients with multiple organ dysfunction syndrome (MODS) following open heart surgery. Thorac Cardiovasc Surg 49:273–8]CrossRefPubMedGoogle Scholar
  16. 16.
    Harbarth S, Holeckova K, Froidevaux C, et al (2001) Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 164:396–340Google Scholar
  17. 17.
    Duflo F, Debon R, Monneret G, et al (2002) Alveolar and serum procalcitonin: diagnostic and prognostic value in ventilator-associated pneumonia. Anesthesiology 96:74–79PubMedGoogle Scholar
  18. 18.
    Angus DC, Linde-Zwirble WT, Lidicer J, et al (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310PubMedGoogle Scholar
  19. 19.
    Marshall JC, Cook DJ, Christou NV, et al (1995) Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23:1638–1652PubMedGoogle Scholar
  20. 20.
    Ferreira FL, Bota DP, Bross A, et al (2002) Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 286:1754–1758Google Scholar
  21. 21.
    Wilkinson JD, Pollack MM, Ruttiman, et al (1986) Outcome of pediatric patient with multiple organ system failure Crit Care Med 14:271–274Google Scholar
  22. 22.
    Proulx F, Fagan M, Farrell CA, et al (1996) Epidemiology of sepsis and multiple organ dysfunction syndrome in children. Chest 109:1033–1037PubMedGoogle Scholar
  23. 23.
    Doughty LA, Carcillo JA, Kaplan, et al (1996) Plasma nitrite and nitrate concentration and multiple organ failure in pediatric sepsis Crit Care Med 109:1033–1037Google Scholar
  24. 24.
    Leteutre S, Martinot A, Duhamel A, Gauvin F, Grandbastien B, Nam TV, Proulx F LaCroix J, LeClerc Fl (1999) Pediatric logistic dysfunction score. Development of a pediatric multiple organ dysfunction score: use of two strategies. Med Decis Makingaking 19:399-410Google Scholar
  25. 25.
    Carcillo JA, Fields AI (2002) Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 30:1365–1378PubMedGoogle Scholar
  26. 26.
    Denoix PX (1946) Enquete permanent dans les centres anticancereaux. Bull Inst Natl Hyg 1:70–75Google Scholar
  27. 27.
    Gospodarowicz M, Benedet L, Hutter RV, et al (1998) History and international developments in cancer staging. Cancer Prev Control 2:262–268PubMedGoogle Scholar
  28. 28.
    Renaud B, Brun-Buisson C, ICU-Bacteremia Study Group (2001) Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 163:1584–1590PubMedGoogle Scholar
  29. 29.
    Opal SM, Cohen J (1999) Clinical gram-positive sepsis: does it fundamentally differ from gram-negative bacterial sepsis? Crit Care Med 27:1608–1616PubMedGoogle Scholar
  30. 30.
    Ziegler EJ, Fisher CJ Jr, Sprung CL, et al (1991) Treatment of Gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin: a randomized, double-blind, placebo-controlled trial. N Engl J Med 324:429–436Google Scholar
  31. 31.
    Wortel CH, von der Mohlen MAM, van Deventer SJH, et al (1992) Effectiveness of a human monoclonal anti-endotoxin antibody (HA-1A) in gram-negative sepsis: relationship to endotoxin and cytokine levels. J Infect Dis 166:1367–1374Google Scholar
  32. 32.
    McCloskey RV, Straube RC, Sanders C, et al (1994) Treatment of septic shock with human monoclonal antibody HA-1A: a randomized, double-blind, placebo-controlled trial. Ann Intern Med 121:1–5PubMedGoogle Scholar
  33. 33.
    Hausfater P, Garric S, Ayed SB, et al (2002) Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study. Clin Infect Dis 34:895–901PubMedGoogle Scholar
  34. 34.
    Damas P, Ledoux D, Nys M, et al (1992) Cytokine serum level during severe sepsis in human IL-6 as a marker of severity. Ann Surg 215:356–362PubMedGoogle Scholar
  35. 35.
    Panacek EA, Kaul M (1999) IL-6 as a marker of excessive TNF-alpha activity in sepsis. Sepsis 3:65–73CrossRefGoogle Scholar
  36. 36.
    Bernard GR, Vincent J-L, Laterre PF, et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709PubMedGoogle Scholar
  37. 37.
    Annane D, Sébille V, Charpentier C, et al (2002) Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862–871PubMedGoogle Scholar
  38. 38.
    Vincent J-L, Moreno R, Takala J, et al on behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine (1996) The SOFA (Sepsis-Related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  39. 39.
    Marshall JC, Panacek EA, Teoh L, et al (2001) Modeling organ dysfunction as a risk factor, outcome, and measure of biologic effect in sepsis. Crit Care Med 28:A46Google Scholar
  40. 40.
    Eli Lilly and Company (2001) Briefing document for XIGRIS for the treatment of severe sepsis. http:www.fda.gov/ohrms/dockets/ac/01/briefing/3797b1_01_Sponsor.htm, 6 AugustGoogle Scholar
  41. 41.
    Cook R, Cook DJ, Tilley J, et al for the Canadian Critical Care Trials Group (2001) Multiple organ dysfunction: baseline and serial component scores. Crit Care Med 29:2046–2050PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Mitchell M. Levy
    • 1
  • Mitchell P. Fink
    • 2
  • John C. Marshall
    • 3
  • Edward Abraham
    • 4
  • Derek Angus
    • 5
  • Deborah Cook
    • 6
  • Jonathan Cohen
    • 7
  • Steven M. Opal
    • 8
  • Jean-Louis Vincent
    • 9
  • Graham Ramsay
    • 10
  • for the International Sepsis Definitions Conference
    • 1
  1. 1.Rhode Island HospitalUSA
  2. 2.University of Pittsburgh Medical CenterUSA
  3. 3.Toronto General HospitalTorontoCanada
  4. 4.University of Colorado Health Sciences CenterUSA
  5. 5.University of Pittsburgh School of MedicineUSA
  6. 6.St. Joseph's HospitalHamiltonCanada
  7. 7.Imperial College of MedicineLondonUK
  8. 8.Brown University School of Medicine, Memorial Hospital of Rhode IslandUSA
  9. 9.University Hospital ErasmeBrusselsBelgium
  10. 10.University HospitalMaastrichtThe Netherlands

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