Judging quality of current septic shock definitions and criteria

Abstract

Septic shock definitions are being revisited. We assess the feasibility, reliability, and validity characteristics of the current definitions and criteria of septic shock. Septic shock is conceptualised as cardiovascular dysfunction, tissue perfusion and cellular abnormalities caused by infection. Currently, for feasibility, septic shock is identified at the bedside by using either hypotension or a proxy for tissue perfusion/cellular abnormalities (e.g., hyperlactatemia). We propose that concurrent presence of cardiovascular dysfunction and perfusion/cellular abnormalities could improve validity of septic shock diagnosis, as we are more likely to identify a patient population with all elements of the illness concept. This epidemiological refinement should not affect clinical care and may aid study design to identify illness-specific biomarkers and interventions.

Fig. 1

Simplified overview of septic shock biology

Fig. 2

Secular trends in septic shock mortality. Cub-REA Data were provided by Philippe Aegerter, Bertrand Guidet and D. Annane for the Cub-REA network, which used International Classification of Diseases (ICD)-9 and ICD-10 codes and the Bone definition [16]. GiViTI data were provided by Bertolini et al. using 2001 Consensus Definitions [16, 17]. ANZICS data, provided by Bellomo et al. (personal communications), used hypotension as the definition for septic shock. Brunkhorst et al. (personal communications) provided German data for 2011, using ICD codes for the diagnosis of septic shock