Applying the 2003 SCCM/ESICM/ACCP/ATS/SIS instead of the 1992 ACCP/SCCM sepsis definitions increases the numbers of patients with systemic inflammatory response syndrome shock and septic shock but decreases mortality rates

Introduction

To compare the prevalence of patients suffering from different stages of systemic inflammatory response syndrome (SIRS) and sepsis applying the original 1992 ACCP/SCCM and the revised 2003 SCCM/ESICM/ACCP/ATS/SIS sepsis definitions.

Methods

Set in a university adult ICU. Patients were postoperative/post-traumatic critically ill patients admitted to the ICU from October 2006 to October 2007. No interventions were used. From October 2006 to October 2007, 714 patients were surveyed using computer assistance with respect to different stages of SIRS and sepsis using the 1992 and the 2003 sepsis definitions, respectively.

Results

Within the same patient collective, applying the 2003 definitions instead of the 1992 definitions, the prevalence of no SIRS (11 vs 110, respectively), no SIRS due to infection (sepsis) (0 vs 12), SIRS (129 vs 169) and sepsis (18 vs 52) decreased, and the prevalence of severe SIRS (169 vs 86), SIRS shock (121 vs 65) and septic shock (216 vs 168) increased. Prevalence of severe sepsis was comparable with both definitions (50 vs 52). Applying the 2003 definitions in patients with SIRS shock and septic shock, the mortality rates of 17% and 25% were markedly lower than those of 23% and 30%, respectively, under the 1992 definitions. Compared with the patients classified to be without SIRS shock and septic shock, the risk of mortality of those patients was markedly elevated that were classified to be in SIRS shock or septic shock with the 2003 definitions but not with the 1992 definitions (odds ratio = 5.0, CI = 2.2–11.2, P < 0.0001).

Conclusion

Replacing the original 1992 sepsis definitions with the 2003 revised sepsis definitions may result in increased prevalence of severe SIRS, SIRS shock and septic shock. However, the mortality rates of patients with SIRS shock and septic shock will be lower.