2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
- 9.1k Downloads
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.
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).
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.
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.
KeywordsSepsis Severe Sepsis Septic Shock SIRS PIRO
- 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.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
- 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
- 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.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.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.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
- 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.Wilkinson JD, Pollack MM, Ruttiman, et al (1986) Outcome of pediatric patient with multiple organ system failure Crit Care Med 14:271–274Google Scholar
- 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.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
- 26.Denoix PX (1946) Enquete permanent dans les centres anticancereaux. Bull Inst Natl Hyg 1:70–75Google Scholar
- 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.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
- 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.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.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