About 1300 years ago, the Greeks adopted the term σήyις (sepsis) to define processes of decomposition or rotting, clinical conditions burdened by high mortality and often associated with infectious processes. However, during the twentieth century, there was a need to adopt a more accurate and functional definition, which has evolved substantially in three consecutive times (1992, 2001, and 2016) (Fig. 1). In the consensus conference held in 1992 between the American College of Chest Physicians and the Society of Critical Care Medicine, sepsis was defined as the result of the host’s systemic inflammatory response syndrome (SIRS) to an infection, either established or suspected. Thus, in other words, sepsis was defined as the result of two conditions: suspected infection and SIRS. SIRS represents the first stage of a systemic inflammatory process of different etiologies (trauma, infection, burns, pancreatitis, etc.) and is diagnosed according to the presence of at least two of the following symptoms or signs:

• Body temperature >38 °C or <36°C

• Heart rate >90 beats/minute

• Respiratory rate >20 acts/minute or partial pressure of carbon dioxide (PaCO2) <32 mmHg (4.3 kPa)

• White blood cell count >12,000/mm³ or 10% immature neutrophil form

Fig1. Timeline of sepsis definition. Copyright EDISES 2021. (Reproduced with permission)

Sepsis complicated by organ dysfunction was defined as severe sepsis, which could progress to septic shock, defined as “sepsis-induced hypotension that persists despite adequate fluid infusion.” In 2001, a task force of 29 experts, recognizing the limitations of these definitions, expanded the list of diagnostic criteria by adding further signs, symptoms, and biochemical tests but did not change them. The definitions of sepsis, septic shock, and organ dysfunction have remained unchanged for over two decades.

A better understanding of the pathobiology of sepsis as sepsis-induced alterations on organ function, morphology, cell biology, biochemistry, immunology, and circulation has led to the need to revise its definition. In 2014, a task force of 19 experts developed the consensus “Sepsis-3,” which fundamentally revolutionized the old definition of sepsis, eliminating the concept of SIRS and deleting the term severe sepsis. Thus, the results of the Sepsis-3 consensus, published in 2016, defined the following conditions:

• Organ dysfunction: condition represented by an increase in Sequential Organ Failure Assessment (SOFA) score of at least two points.

• Sepsis: life-threatening organ dysfunction due to a host’s dysregulated biological response during an infection.

 • Septic shock: a specific type of sepsis in which severe metabolic, circulatory, and cellular alterations confer a higher risk of death than in the presence of sepsis alone.

The SOFA (Sequential Organ Failure Assessment) is a 0–4 score that explores the progressive deterioration of the respiratory, cardiovascular, hepatic, renal, neurological, and coagulation systems.

This new definition of sepsis ideally relates to a historic definition by William Osler, formulated early last century: “with some exceptions, the patient appears to die from the organic response to the infection rather than from the infection itself.”

The original concept of sepsis, defined as an infection with at least two of the four SIRS criteria, focused exclusively on inflammatory excess. Today, however, it is recognized that sepsis is something more complex than an infection presenting along with inflammation. It is known that it involves the early activation of both pro- and anti- inflammatory responses associated with essential changes in several pathways, including cardio vascular, neuronal, hormonal, bioenergetic, metabolic, and coagulative. In other words, sepsis is now defined as an infection complicated by organ dysfunction, dangerous for survival, and caused by a dysregulated response of the organism.

Since the SOFA score appears rather complex, especially in urgent/emergencies, slowing down the early recognition of sepsis in a suspected patient, a simplified surrogate, called qSOFA (quick SOFA), has been developed based on three elementary parameters:

• Respiratory rate ≥22 acts/minute

• Mental alteration

• Blood pressure ≤100 mmHg

If the patient has at least two of the above parameters, there is a high probability of sepsis. Compared to the SOFA score, the qSOFA is based solely on clinical criteria and does not require laboratory testing, thus providing a more straight forward and faster assessment of the patient with suspected sepsis (Fig. 2).

Fig2. Diagnostic algorithm for sepsis and septic shock. qSOFA quick Sequential Organ Failure Assessment, SOFA Sequential Organ Failure Assessment. (Copyright EDISES 2021. Reproduced with permission)

However, it should be emphasized that whatever tool is used in the initial patient evaluation, none of the simple or complex scoring systems can make a definitive diagnosis of sepsis but rather serve as a screening tool to direct the clinician toward a targeted diagnostic workup. This is particularly important because various other diseases, such as polytrauma, acute pancreatitis, and venous thromboembolism, share the signs and symptoms of sepsis.

اخر الاخبار

اخبار العتبة العباسية المقدسة

دار الكفيل تنهي طباعة كتاب (لمَ لا) تمهيدًا لمناقشته في ملتقى غيث السماء القرآني الثاني

العتبة العباسية المقدسة تطلق مسابقتها الثقافية بذكرى ولادة الإمام زين العابدين (عليه السلام)

العتبة العباسية المقدسة تكرّم 1000 طالبة من المرتديات العباءة العراقية في مدارس الديوانية

العتبة العباسية المقدسة تؤكد أهمية الحجاب كجزء من منظومة الواجبات الشرعية

المزيد

الآخبار الصحية

الخبز الأسمر أم الأبيض.. أيهما أفضل لضبط سكر الدم؟

عقاقير التخسيس و"الانتحار".. الحكومة الأميركية تحسم الجدل

الهرم الغذائي الجديد.. لماذا يعد "انقلابا" في خارطة الطعام؟

لحماية ظهرك وقلبك في آن واحد.. ما وضعية النوم الصحيحة؟

المزيد

الآخبار التكنلوجية

كيف يعزز الضوء الطبيعي تفكيرك وانتباهك خلال اليوم

سابقة.. طاقم من محطة الفضاء الدولية يعود إلى الأرض مبكرا

منصات التواصل تضرّ بنفسية المراهقين… والفتيات الأكثر تأثرا

ابتكار ألماني قد يغيّر مستقبل صناعة البلاستيك

المزيد

مواضيع ذات صلة

Types of Bloodstream Infections

Frontotemporal and Vascular Dementias

Alzheimer’s Disease

Human Prion Diseases

Diabetes treatments

Preeclampsia and Eclampsia

Gestational Diabetes

Clinical Manifestations of Aging and Hematopoiesis

Reactions of Blood Vessels in Acute Inflammation

Cellular Aging

Pathologic Calcification

Acute Lymphoblastic Leukemia