This cohort study in the January 17, 2017 issue of JAMA looks at the

Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department

The study concluded that the quick Sequential Organ Failure Assessment (qSOFA) score is better than the systemic inflammatory response syndrome (SIRS) or severe sepsis criteria in the emergency department setting at identifying patients with suspected infections

These findings provide support for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in the emergency department setting.

Sepsis is a highly prevalent condition that accounts for 10% of admissions to the intensive care unit (ICU) and is associated with a 10% to 20% in-hospital mortality rate.

The task force derived and validated its criteria on several large patient databases, both inside and outside the ICU. They reported that qSOFA (range, 0-3; 1 point for each of the following: respiratory rate >21 breaths/min; systolic arterial blood pressure ≤100 mm Hg; or altered mental status) was a better predictor for in-hospital mortality than were SIRS or SOFA in non-ICU encounters and should be used for risk stratification and consideration for sepsis in emergency department (ED) patients with infection.

The authors noted that this study was not been prospectively validated or even studied specifically in the ED. For Sepsis-3 criteria to be globally endorsed, external validation is essential.

Of note, from an August 29, 2013 NEJM article, pneumonia is the most common cause, accounting for just over fifty percent, followed by intraabdominal and urinary tract infections.

Blood cultures are typically positive in only one third of cases, and in up to a third of cases, cultures from all sites are negative.

The most common gram-positive organisms are Staphylococcus aureus and Streptococcus pneumonia.  The most common gram-negative organisms are Escherichia coli, klebsiella species, and Pseudomonas aeruginosa

An epidemiologic study of sepsis showed that during the period from 1979 to 2000, gram-positive infections overtook gram-negative infections.

However, in a more recent study involving 14,000 ICU patients in 75 countries, gram-negative bacteria were isolated in 62% of patients with severe sepsis who had positive cultures, gram-positive bacteria in 47%, and fungi in 19%.


Source: Evaluating the Validity of Sepsis-3 Criteria in the Emergency Department