AME evidence series 001-The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhongheng Zhang¹, Nathan J Smischney², Haibo Zhang³, Sven Van Poucke⁴, Panagiotis Tsirigotis⁵, Jordi Rello⁶, Patrick M Honore⁷, Win Sen Kuan⁸, Juliet June Ray⁹, Jiancang Zhou¹⁰, You Shang¹¹, Yuetian Yu¹², Christian Jung¹³, Chiara Robba¹⁴, Fabio Silvio Taccone¹⁵, Pietro Caironi¹⁶, David Grimaldi¹⁷, Stefan Hofer¹⁸, George Dimopoulos¹⁹, Marc Leone²⁰, Sang-Bum Hong²¹, Mabrouk Bahloul²², Laurent Argaud²³, Won Young Kim²⁴, Herbert D Spapen⁷, Jose Rodolfo Rocco²⁵

Affiliations

¹ Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;; Department of Critical Care Medicine, Jinhua Hospital of Zhejiang University, Jinhua 321000, China.
² Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
³ Keenan Research Center for Biomedical Science of St. Michael's Hospital, Departments of Anesthesia and Physiology, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Departments of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
⁵ 2nd Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁶ CIBERES, Vall d'Hebron Institut of Research, Universitat Autonoma de Barcelona, Spain.
⁷ Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium.
⁸ Emergency Medicine Department, National University Hospital, National University Health System, Singapore and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁹ DeWitt Daughtry Family Department of Surgery, Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
¹⁰ Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
¹¹ Department of Critical Care Medicine, Union Hospital, Tongji Medical Collegue, Huazhong University of Science and Technology, Wuhan 430022, China.
¹² Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
¹³ University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany.
¹⁴ Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
¹⁵ Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹⁶ Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
¹⁷ Intensive Care Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
¹⁸ Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
¹⁹ Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²⁰ Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
²¹ Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²² Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.
²³ Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
²⁴ Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²⁵ Department of Internal Medicine and Post-graduated Program, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

PMID: 27747021
PMCID: PMC5059246
DOI: 10.21037/jtd.2016.08.03

Review

AME evidence series 001-The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhongheng Zhang et al. J Thorac Dis. 2016 Sep.

. 2016 Sep;8(9):2654-2665.

doi: 10.21037/jtd.2016.08.03.

Authors

Affiliations

¹ Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;; Department of Critical Care Medicine, Jinhua Hospital of Zhejiang University, Jinhua 321000, China.
² Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
³ Keenan Research Center for Biomedical Science of St. Michael's Hospital, Departments of Anesthesia and Physiology, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Departments of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
⁵ 2nd Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁶ CIBERES, Vall d'Hebron Institut of Research, Universitat Autonoma de Barcelona, Spain.
⁷ Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel Brussels, Brussels, Belgium.
⁸ Emergency Medicine Department, National University Hospital, National University Health System, Singapore and the Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁹ DeWitt Daughtry Family Department of Surgery, Jackson Memorial Hospital, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
¹⁰ Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
¹¹ Department of Critical Care Medicine, Union Hospital, Tongji Medical Collegue, Huazhong University of Science and Technology, Wuhan 430022, China.
¹² Department of Critical Care Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China.
¹³ University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany.
¹⁴ Neurosciences Critical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
¹⁵ Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium.
¹⁶ Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
¹⁷ Intensive Care Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
¹⁸ Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
¹⁹ Department of Critical Care, University Hospital ATTIKON, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²⁰ Service d'anesthésie et de réanimation, Hôpital Nord, Assistance Publique - Hôpitaux de Marseille, Aix Marseille Université, Marseille, France.
²¹ Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²² Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.
²³ Medical Intensive Care Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
²⁴ Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²⁵ Department of Internal Medicine and Post-graduated Program, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

PMID: 27747021
PMCID: PMC5059246
DOI: 10.21037/jtd.2016.08.03

Abstract

Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for clinical use of different diagnostic tools rely on the Grades of Recommendation Assessment, Development and Evaluation (GRADE) framework. Because most of the studies were observational and did not allow a reliable assessment of these tools, a two-step inference approach was employed. Future trials need to confirm or refute a particular index test and should directly explore relevant patient outcome parameters.

Keywords: Sepsis; diagnosis; early identification.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

**Figure 1**
Two methods to evaluate the clinical usefulness of a diagnostic test. Randomized controlled trials can provide the highest quality of evidence because they directly compare patient-important outcomes between the group managed with index test and the control group. Observational cohort studies provide diagnostic accuracy and allow judgment on impact of each diagnostic result (true positive, false positive, false negative, and true negative) on relevant patient outcomes.

See this image and copyright information in PMC

Comment in

Perspectives and implications of the new sepsis clinical practice guidelines.
McCormack D, Kulkarni M, Keller SE. McCormack D, et al. J Thorac Dis. 2016 Oct;8(10):E1355-E1357. doi: 10.21037/jtd.2016.09.58. J Thorac Dis. 2016. PMID: 27867626 Free PMC article. No abstract available.
More challenges around sepsis: definitions and diagnosis.
Joynes E. Joynes E. J Thorac Dis. 2016 Nov;8(11):E1467-E1469. doi: 10.21037/jtd.2016.11.10. J Thorac Dis. 2016. PMID: 28066632 Free PMC article. No abstract available.
'σήψις' yesterday, sepsis nowadays: what's changing?
Cutuli SL, De Pascale G, Antonelli M. Cutuli SL, et al. J Thorac Dis. 2017 Feb;9(2):E166-E167. doi: 10.21037/jtd.2017.02.43. J Thorac Dis. 2017. PMID: 28275507 Free PMC article. No abstract available.

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AME evidence series 001-The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Affiliations

AME evidence series 001-The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

LinkOut - more resources

Full Text Sources

Other Literature Sources

Research Materials