Sepsis Definitions: I Know It When I See It*

 

by Parker, Margaret M. 

 

Critical Care Medicine: January 2022 - Volume 50 - Issue 1 - p 148-150

 

Justice Potter Stewart’s comment regarding pornography that while he “wouldn’t attempt further to define it…I know it when I see it” could just as readily be said in reference to sepsis. Over the past 3–4 decades, efforts have been made to define sepsis, severe sepsis, and septic shock more objectively. For purposes of this editorial, “sepsis” will include the full spectrum of sepsis, severe sepsis, and septic shock. Why is sepsis so difficult to define? There are many signs, symptoms, and laboratory abnormalities that commonly occur in patients with sepsis, but there is not a single “gold standard” definition or criterion that clinicians can all agree on and that facilitates the prompt recognition of the syndrome. The manifestations of sepsis are highly variable, and an infecting organism is not identified in over a third of the patients (1). In children, the diagnosis is further complicated by age- and size-dependent developmental changes. Why is it important to have objective criteria with which to define sepsis? The principal reason is that the prompt recognition and treatment of sepsis have been shown to improve survival (2,3). In comparison with patients in the Emergency Department, recognition of sepsis in hospital inpatients is frequently delayed with a consequent delay in antibiotic therapy and increase in mortality (4,5). An additional and possibly equally important reason to have objective criteria to define sepsis is to enable research studies to be carried out on appropriate populations, which will enhance valid comparison of clinical trials that focus on comparable patient populations…