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Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients

A Cohort Study in 49 ICUs in Argentina

Estenssoro, Elisa, MD1; Kanoore Edul, Vanina S., MD2; Loudet, Cecilia I., MD, MSc1; Osatnik, Javier, MD3; Ríos, Fernando G., MD4; Vázquez, Daniela N., MD5; Pozo, Mario O., MD6; Lattanzio, Bernardo, MD7; Pálizas, Fernando, MD6; Klein, Francisco, MD8; Piezny, Damián, MD4; Rubatto Birri, Paolo N., MD9; Tuhay, Graciela, MD8; Díaz, Anatilde, MD10; Santamaría, Analía, MD11; Zakalik, Graciela, MD12; Dubin, Arnaldo, MD, PhD9 on behalf of SATISEPSIS Investigators

doi: 10.1097/CCM.0000000000003208
Clinical Investigations

Objectives: The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina.

Design: Cohort study of 3-month duration beginning on July 1, 2016.

Settings: Forty-nine ICUs.

Patients: Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration.

Interventions: None.

Measurements and Main Results: Patients were classified as having infection, sepsis (infection + change in Sequential Organ Failure Assessment ≥ 2 points), and septic shock (vasopressors + lactate > 2 mmol/L). Patients on vasopressors and lactate less than or equal to 2 mmol/L (cardiovascular dysfunction) were analyzed separately, as those on vasopressors without serum lactate measurement. Systemic inflammatory response syndrome was also recorded. Main outcome was hospital mortality. Of 809 patients, 6% had infection, 29% sepsis, 20% cardiovascular dysfunction, 40% septic shock, and 3% received vasopressors with lactate unmeasured. Hospital mortality was 13%, 20%, 39%, 51%, and 41%, respectively (p = 0.000). Independent predictors of outcome were lactate, Sequential Organ Failure Assessment score, comorbidities, prior duration of symptoms (hr), mechanical ventilation requirement, and infection by highly resistant microorganisms. Area under the receiver operating characteristic curves for mortality for systemic inflammatory response syndrome and Sequential Organ Failure Assessment were 0.53 (0.48–0.55) and 0.74 (0.69–0.77), respectively (p = 0.000).

Conclusions: Increasing severity of Sepsis-3 categories adequately tracks mortality; cardiovascular dysfunction subgroup, not included in Sepsis-3, has distinct characteristics. Sequential Organ Failure Assessment score shows adequate prognosis accuracy─contrary to systemic inflammatory response syndrome. This study supports the predictive validity of Sepsis-3 definitions.

1Hospital Interzonal de Agudos San Martin de La Plata, La Plata, Buenos Aires, Argentina.

2Hospital Juan A Fernández, Ciudad Autónoma de Buenos Aires, Argentina.

3Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.

4Hospital Alejandro Posadas, El Palomar, Buenos Aires, Argentina.

5Sanatorio Anchorena, Ciudad Autónoma de Buenos Aires, Argentina.

6Clínica Bazterrica, Ciudad Autónoma de Buenos Aires, Argentina.

7Clínica Santa Isabel, Ciudad Autónoma de Buenos Aires, Argentina.

8Hospital Universitario Fundación Favaloro, Ciudad Autónoma de Buenos Aires, Argentina.

9Sanatorio Otamendi y Miroli, Ciudad Autónoma de Buenos Aires, Argentina.

10Hospital Misericordia, Ciudad de Córdoba, Córdoba, Argentina.

11Sanatorio de la Trinidad Mitre, Ciudad Autónoma de Buenos Aires, Argentina.

12Hospital Lagomaggiore, Ciudad de Mendoza, Mendoza, Argentina.

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Supported, in part, by a grant of the National Ministry of Health (2014) given to the Sociedad Argentina de Terapia Intensiva.

Dr. Pálizas disclosed government work and disclosed that this research was organized by a Committee of the Argentine Society of Critical Care Medicine (SATI); SATI received some funding from the Ministry of Health due to the epidemiologic importance of the study. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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