Annales françaises de médecine d'urgence

, Volume 7, Issue 1, pp 30–34 | Cite as

Sepsis : définitions et validations

Mise au Point / Update
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Résumé

Le sepsis est un syndrome complexe regroupant plusieurs entités cliniques. Il reste associé à une mortalité élevée. La reconnaissance précoce des patients à risque d’évolution défavorable est un des éléments déterminants du pronostic. Cette identification s’appuyait jusqu’en 2016 sur une classification datée de 1991 et réactualisée en 2001. Elle distinguait quatre entités considérées comme les phases d’aggravation progressive de l’infection et de la réponse inflammatoire à celle-ci: l’infection, le sepsis, le sepsis sévère et le choc septique. Ces définitions présentaient plusieurs limites, expliquant la démarche initiée en 2016 par un groupe international d’experts (SEPSIS-3) visant à simplifier et améliorer la classification des états septiques aigus. On distingue désormais uniquement le sepsis et le choc septique. Ces nouvelles définitions mettent l’accent sur la notion de dysfonction d’organe menaçant le pronostic vital. L’association entre mortalité et défaillance d’organe se retrouve dans le score SOFA (Sequential [Sepsis-Related] Organe Failure Assessment) et sa version simplifiée le qSOFA (quick SOFA). Ces nouveaux critères issus de données rétrospectives à partir de populations sélectionnées nécessitent une validation prospective, notamment dans les services d’urgence. Cette validation a été récemment menée dans le contexte de l’étude internationale SCREEN, confirmant entre autres, les performances pronostiques du score qSOFA.

Mots clés

Sepsis qSOFA Mortalité 

Sepsis: Definitions and validations

Abstract

Sepsis is a complex syndrome including several clinical entities. It remains associated with a high mortality. Early recognition of patients at risk of unfavorable evolution is one of the determining elements for the prognosis. This identification leaned until 2016 on a classification dated in 1991 and updated in 2001. It distinguished four entities considered as the phases of progressive worsening of the infection and the inflammatory answer to this one: infection, sepsis, severe sepsis and septic shock. These definitions presented several limits, explaining the approach introduced in 2016 by an international group of experts (SEPSIS-3) to simplify and improve the classification of sepsis, which recognizes from now on only sepsis and septic shock. These new definitions emphasize the notion of life-threatening organ dysfunction. The association between mortality and organ dysfunction is based on the SOFA (Sequential [Sepsis-Related] Organ Failure Assessment) score and its simplified version the qSOFA score (quick SOFA). These new criteria extracted from retrospective data and selected populations require a prospective validation, particularly in the emergency department setting. This validation was recently led in the context of the international study SCREEN, confirming among others, the predictive validity of the qSOFA score.

Keywords

Sepsis qSOFA Mortality 

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Copyright information

© Société française de médecine d'urgence and Lavoisier 2017

Authors and Affiliations

  1. 1.Sorbonne Universités, UPMC Paris Univ-06ParisFrance
  2. 2.Service d’accueil des urgences, hôpital Pitié-SalpêtrièreAssistance Publique des Hôpitaux de Paris (AP-HP)ParisFrance

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