Is the Sepsis-3 definition useful in the management of patients with complicated intra-abdominal infections?

Abstract

Sepsis-3 definition introduces Quick SOFA (qSOFA) as a tool for identifying patients at risk of sepsis with a higher risk of hospital death both inside and outside critical care units. However qSOFA does not define sepsis and the new sepsis definitions recommend using an increase in the SOFA score of 2 points or more to represent organ dysfunction. The SOFA score, is potentially not accessible everywhere, especially for PaO₂, which would require an arterial blood gas measurement. In order to validate a new practical sepsis severity score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression a prospective study was conducted around the world from October 2014 to February 2015. The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period. The data from WISS study showed that mortality was significantly affected by the old sepsis definition. Mortality by sepsis status was: no sepsis 1.2%, sepsis only 4.4%, severe sepsis 27.8% and septic shock 67.8%. Early detection and timely therapeutic intervention improved the prognosis and overall clinical outcome of patients. Severe sepsis represented a reasonable approximation of the tipping point between stable and critical clinical conditions in management of patients with intra-abdominal infections. In patients with complicated intra-abdominal infections, SIRS signs associated with abdominal signs screened patients needing immediate acute care surgery and old sepsis definition better recognized patients at earlier stages when the infective process is most treatable.