Sepsis-3 Septic Shock Criteria and Associated Mortality Among Infected Hospitalized Patients Assessed by a Rapid Response Team


      Rapid response teams (RRTs) respond to hospitalized patients with deterioration and help determine subsequent management, including ICU admission. In such patients with sepsis and septic shock, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) clinical criteria have a potential role in detection, risk stratification, and prognostication; however, their accuracy in comparison with the systemic inflammatory response syndrome (SIRS)-based septic shock criteria is unknown. We sought to evaluate prognostic accuracy of the Sepsis-3 criteria for in-hospital mortality among infected hospitalized patients with acute deterioration.


      Prospectively collected registry data (2012-2016) from two hospitals, including consecutive hospitalized patients with suspected infection seen by the RRT. We compared the Sepsis-3 criteria with the SIRS-based criteria for prediction of in-hospital mortality.


      Of 1,708 included patients, 418 (24.5%) met the Sepsis-3 septic shock criteria, whereas 545 (31.9%) met the SIRS-based septic shock criteria. Patients meeting the Sepsis-3 septic shock criteria had higher in-hospital mortality (40.9% vs 33.5%; P < .0001), ICU admission (99.5% vs 89.2%; P < .001), and discharge rates to long-term care (66.3% vs 53.7%; P < .0001) than patients meeting the SIRS-based septic shock criteria, respectively. Sensitivity and specificity of the quick Sequential (Sepsis-Related) Organ Failure Assessment were 64.9% and 92.2% for prediction of in-hospital mortality, whereas SIRS criteria had a sensitivity and specificity of 91.6% and 23.6%, respectively.


      Hospitalized patients with deterioration from suspected infection had higher risk of in-hospital mortality if they met the Sepsis-3 septic shock criteria than the SIRS-based septic shock criteria. Therefore, use of the Sepsis-3 criteria may be preferable in the prognostication and disposition of these patients who are critically ill.

      Key Words


      AUROC (area under the receiver operating characteristic curve), qSOFA (quick Sequential (Sepsis-Related) Organ Failure Assessment), RRT (rapid response team), Sepsis-3 (Third International Consensus Definitions for Sepsis and Septic Shock), SIRS (systemic inflammatory response syndrome), SOFA (Sequential (Sepsis-Related) Organ Failure Assessment)
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        • Kempker J.A.
        • Martin G.S.
        The changing epidemiology and definitions of sepsis.
        Clin Chest Med. 2016; 37: 165-179
        • Dugani S.
        • Veillard J.
        • Kissoon N.
        Reducing the global burden of sepsis.
        CMAJ. 2017; 189: E2-E3
        • Lagu T.
        • Rothberg M.B.
        • Shieh M.S.
        • Pekow P.S.
        • Steingrub J.S.
        • Lindenauer P.K.
        Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007.
        Crit Care Med. 2012; 40: 754-761
        • Esteban A.
        • Frutos-Vivar F.
        • Ferguson N.D.
        • et al.
        Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward.
        Crit Care Med. 2007; 35: 1284-1289
        • Rohde J.M.
        • Odden A.J.
        • Bonham C.
        • et al.
        The epidemiology of acute organ system dysfunction from severe sepsis outside of the intensive care unit.
        J Hosp Med. 2013; 8: 243-247
        • Bhattacharjee P.
        • Edelson D.P.
        • Churpek M.M.
        Identifying patients with sepsis on the hospital wards.
        Chest. 2017; 151: 898-907
        • Winters B.D.
        • Weaver S.J.
        • Pfoh E.R.
        • Yang T.
        • Pham J.C.
        • Dy S.M.
        Rapid-response systems as a patient safety strategy: a systematic review.
        Ann Intern Med. 2013; 158: 417-425
        • Maharaj R.
        • Raffaele I.
        • Wendon J.
        Rapid response systems: a systematic review and meta-analysis.
        Crit Care. 2015; 19: 254
        • Jaderling G.
        • Bell M.
        • Martling C.R.
        • Ekbom A.
        • Bottai M.
        • Konrad D.
        ICU admittance by a rapid response team versus conventional admittance, characteristics, and outcome.
        Crit Care Med. 2013; 41: 725-731
        • Chan P.
        • Peake S.
        • Bellomo R.
        • Jones D.
        Improving the recognition of, and response to in-hospital sepsis.
        Curr Infect Dis Rep. 2016; 18: 20
        • Bone R.C.
        • Balk R.A.
        • Cerra F.B.
        • et al.
        Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine.
        Chest. 1992; 101: 1644-1655
        • Sprung C.L.
        • Schein R.M.
        • Balk R.A.
        To SIRS with love-an open letter.
        Crit Care Med. 2016; 45: 736-738
        • Singer M.
        • Deutschman C.S.
        • Seymour C.W.
        • et al.
        The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
        JAMA. 2016; 315: 801-810
        • Vincent J.L.
        • Moreno R.
        • Takala J.
        • et al.
        The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine.
        Intensive Care Med. 1996; 22: 707-710
        • Seymour C.W.
        • Liu V.X.
        • Iwashyna T.J.
        • et al.
        Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
        JAMA. 2016; 315: 762-774
        • Shankar-Hari M.
        • Phillips G.S.
        • Levy M.L.
        • et al.
        Developing a new definition and assessing new clinical criteria for septic shock: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).
        JAMA. 2016; 315: 775-787
        • Ronksley P.E.
        • McKay J.A.
        • Kobewka D.M.
        • Mulpuru S.
        • Forster A.J.
        Patterns of health care use in a high-cost inpatient population in Ottawa, Ontario: a retrospective observational study.
        CMAJ Open. 2015; 3: E111-E118
        • McIsaac D.I.
        • Abdulla K.
        • Yang H.
        • et al.
        Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score-matched observational cohort study.
        CMAJ. 2017; 189: E905-E912
        • Fernando S.M.
        • Reardon P.M.
        • Dowlatshahi D.
        • et al.
        Outcomes and costs of patients admitted to the ICU due to spontaneous intracranial hemorrhage.
        Crit Care Med. 2018; 46: e395-e403
        • Baxter A.D.
        • Cardinal P.
        • Hooper J.
        • Patel R.
        Medical emergency teams at The Ottawa Hospital: the first two years.
        Can J Anaesth. 2008; 55: 223-231
        • Jones A.E.
        • Trzeciak S.
        • Kline J.A.
        The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation.
        Crit Care Med. 2009; 37: 1649-1654
        • Cross G.
        • Bilgrami I.
        • Eastwood G.
        • et al.
        The epidemiology of sepsis during rapid response team reviews in a teaching hospital.
        Anaesth Intensive Care. 2015; 43: 193-198
        • Kaukonen K.M.
        • Bailey M.
        • Suzuki S.
        • Pilcher D.
        • Bellomo R.
        Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.
        JAMA. 2014; 311: 1308-1316
        • Stevenson E.K.
        • Rubenstein A.R.
        • Radin G.T.
        • Wiener R.S.
        • Walkey A.J.
        Two decades of mortality trends among patients with severe sepsis: a comparative meta-analysis*.
        Crit Care Med. 2014; 42: 625-631
        • Sterling S.A.
        • Puskarich M.A.
        • Glass A.F.
        • Guirgis F.
        • Jones A.E.
        The impact of the Sepsis-3 septic shock definition on previously defined septic shock patients.
        Crit Care Med. 2017; 45: 1436-1442
        • Henning D.J.
        • Puskarich M.A.
        • Self W.H.
        • et al.
        An emergency department validation of the SEP-3 sepsis and septic shock definitions and comparison with 1992 consensus definitions.
        Ann Emerg Med. 2017; 70: 544-552
        • Deutschman C.S.
        Sepsis-3: seeing the entire picture.
        Crit Care Med. 2017; 45: 1567-1569
        • Kaukonen K.M.
        • Bailey M.
        • Pilcher D.
        • Cooper D.J.
        • Bellomo R.
        Systemic inflammatory response syndrome criteria in defining severe sepsis.
        N Engl J Med. 2015; 372: 1629-1638
        • Vincent J.L.
        Dear SIRS, I'm sorry to say that I don't like you.
        Crit Care Med. 1997; 25: 372-374
        • Churpek M.M.
        • Snyder A.
        • Han X.
        • et al.
        Quick Sepsis-related Organ Failure Assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit.
        Am J Respir Crit Care Med. 2017; 195: 906-911
        • Freund Y.
        • Lemachatti N.
        • Krastinova E.
        • et al.
        Prognostic accuracy of Sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department.
        JAMA. 2017; 317: 301-308
        • Raith E.P.
        • Udy A.A.
        • Bailey M.
        • et al.
        Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit.
        JAMA. 2017; 317: 290-300
        • Fernando S.M.
        • Tran A.
        • Taljaard M.
        • et al.
        Prognostic accuracy of the quick sequential organ failure assessment for mortality in patients with suspected infection: a systematic review and meta-analysis.
        Ann Intern Med. 2018; 168: 266-275
        • LeGuen M.
        • Ballueer Y.
        • McKay R.
        • Eastwood G.
        • Bellomo R.
        • Jones D.
        Frequency and significance of qSOFA criteria during adult rapid response team reviews: a prospective cohort study.
        Resuscitation. 2018; 122: 13-18
        • Churpek M.M.
        • Snyder A.
        • Sokol S.
        • Pettit N.N.
        • Edelson D.P.
        Investigating the impact of different suspicion of infection criteria on the accuracy of quick sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores.
        Crit Care Med. 2017; 45: 1805-1812