From: Ground truth labels challenge the validity of sepsis consensus definitions in critical illness
Item (number) or characteristic | Affirmative/non-affirmative responsesa | Affirmative responsesb | ||||
---|---|---|---|---|---|---|
All edited GTSQs (n = 7291) | Neither SIRS nor sepsis (n = 2206) | SIRS (n = 1056) | Sepsis (n = 732) | Severe sepsis (n = 1167) | Septic shock (n = 2012) | |
Encounters contributing n GTSQs | 798 | 523 | 266 | 183 | 174 | 264 |
GTSQs per contributing encounter | ||||||
Median (interquartile range) | 5 (2–12) | 2 (1–6) | 3 (2–5) | 3 (2–5) | 4 (2–9) | 5 (2–10) |
Suspected infection (4) | 376/6232 (90.6) | 70 (3.2) | 87 (8.2) | 56 (7.7) | 48 (4.1) | 115 (5.7) |
Focus localization (5) | 4184/2982 (98.3) | 233 (10.6) | 232 (22.0) | 646 (88.3) | 1124 (96.3) | 1949 (96.9) |
Localization unclear | 153 (2.1) | 45 (2.0) | 30 (2.8) | 18 (2.5) | 9 (0.8) | 51 (2.5) |
Abdominal, suspected | 387 (5.3) | 9 (0.4) | 21 (2.0) | 33 (4.5) | 91 (7.8) | 233 (11.6) |
Abdominal, confirmed | 1390 (19.1) | 23 (1.0) | 38 (3.6) | 150 (20.5) | 454 (38.9) | 725 (36.0) |
Thoracic, suspected | 834 (11.4) | 23 (1.0) | 48 (4.6) | 124 (16.9) | 199 (17.1) | 440 (21.9) |
Thoracic, confirmed | 1381 (18.9) | 68 (3.1) | 69 (6.5) | 158 (21.6) | 432 (37.0) | 654 (32.5) |
Urogenital, suspected | 49 (0.7) | 2 (0.1) | 4 (0.4) | 5 (0.7) | 16 (1.4) | 22 (1.1) |
Urogenital, confirmed | 110 (1.5) | 2 (0.1) | 1 (0.1) | 22 (3.0) | 35 (3.0) | 50 (2.5) |
Intracranial/meningeal, suspected | 35 (0.5) | 2 (0.1) | 5 (0.5) | 8 (1.1) | 3 (0.3) | 17 (0.8) |
Intracranial/meningeal, confirmed | 239 (3.3) | 34 (1.5) | 5 (0.5) | 58 (7.9) | 68 (5.8) | 74 (3.7) |
Bone/joint, suspected | 65 (0.9) | 9 (0.4) | 4 (0.4) | 7 (1.0) | 22 (1.9) | 23 (1.1) |
Bone/joint, confirmed | 336 (4.6) | 22 (1.0) | 13 (1.2) | 59 (8.0) | 52 (4.5) | 190 (9.4) |
Skin, suspected | 106 (1.5) | 2 (0.1) | 1 (0.1) | 26 (3.6) | 44 (3.8) | 33 (1.6) |
Skin, confirmed | 188 (2.6) | 8 (0.4) | 2 (0.2) | 38 (5.2) | 29 (2.5) | 111 (5.5) |
Blood stream, suspected | 30 (0.4) | 1 (0.1) | – | 4 (0.6) | 5 (0.4) | 20 (1.0) |
Blood stream, confirmed | 243 (3.3) | 11 (0.5) | 7 (0.7) | 61 (8.3) | 62 (5.3) | 102 (5.1) |
Catheter, suspected | 27 (0.4) | 1 (0.1) | – | 8 (1.1) | 1 (0.1) | 17 (0.8) |
Catheter, confirmed | 10 (0.1) | 1 (0.1) | – | 4 (0.6) | – | 5 (0.3) |
Endocarditisc, suspected | 6 (0.1) | 1 (0.1) | 1 (0.1) | 1 (0.1) | 3 (0.3) | – |
Endocarditis, confirmed | 6 (0.1) | – | – | 3 (0.4) | – | 3 (0.2) |
More than 1 focus of infection | 1242 (17.0) | 23 (1.0) | 17 (1.6) | 128 (17.5) | 352 (30.2) | 722 (35.9) |
Source control (6) | 432/6,647 (97.1) | 22 (1.0) | 10 (1.0) | 61 (8.3) | 52 (4.5) | 284 (14.1) |
Surgical | 354 (4.9) | 18 (0.8) | 6 (0.6) | 41 (5.6) | 39 (3.3) | 247 (12.3) |
Interventional | 43 (0.6) | – | 2 (0.2) | 7 (1.0) | 11 (0.9) | 23 (1.1) |
Catheter change | 35 (0.5) | 4 (0.2) | – | 11 (1.5) | 2 (0.2) | 18 (0.9) |
Other | 15 (0.2) | – | 2 (0.2) | 4 (1.6) | 1 (0.1) | 8 (0.4) |
Acute organ dysfunction (9)d | 5267/1649 (94.9) | 963 (43.7) | 756 (71.6) | 524 (71.6) | 1086 (93.1) | 1938 (96,3) |
Gastrointestinal | 831 (11.4) | 41 (1.86) | 8 (6.44) | 69 (9.43) | 176 (15.1) | 477 (23.7) |
Lung | 3961 (54.3) | 348 (15.8) | 511 (48.4) | 372 (50.8) | 948 (81.2) | 1782 (88.6) |
Kidney | 2266 (31.1) | 130 (5.89) | 236 (22.3) | 109 (14.9) | 567 (48.6) | 1224 (60.8) |
Brain | 1796 (24.6) | 628 (28.5) | 292 (27.7) | 160 (21.9) | 204 (17.5) | 512 (25.4) |
Heart | 1061 (14.6) | 58 (2.63) | 125 (11.8) | 57 (7.79) | 118 (10.1) | 703 (34.9) |
Coagulation system | 730 (10.0) | 29 (1.31) | 51 (4.83) | 38 (5.19) | 124 (10.6) | 488 (24.3) |
Bone marrow | 973 (13.3) | 34 (1.54) | 93 (8.81) | 47 (6.42) | 203 (17.4) | 596 (29.6) |
Liver | 805 (11.0) | 13 (0.59) | 71 (6.72) | 15 (2.05) | 168 (14.4) | 538 (26.7) |
Macrocirculatory abnormalities (7) | 3060/4008 (96.9) | 256 (11.6) | 402 (38.1) | 162 (22.1) | 332 (28.4) | 1907 (94.8) |
Volume replacement therapy | 1229 (16.9) | 56 (2.5) | 107 (10.1) | 46 (6.3) | 153 (13.1) | 866 (43.0) |
Capillary leak | 634 (8.7) | 9 (0.4) | 29 (2.8) | 6 (0.8) | 36 (3.1) | 554 (27.5) |
Catecholamine requirement | 2887 (39.6) | 244 (11.1) | 388 (36.7) | 138 (18.9) | 230 (19.7) | 1886 (93.7) |
Microcirculatory dysfunction (8) | 1435/5646 (97.1) | 55 (2.5) | 106 (10.0) | 51 (7.0) | 190 (16.3) | 1033 (51.3) |
Clinical suspicion | 675 (9.3) | 12 (0.5) | 30 (2.8) | 11 (1.5) | 82 (7.0) | 540 (26.8) |
Recapillarization time > 2 s | 122 (1.7) | 6 (0.3) | 5 (0.5) | – | 2 (0.2) | 109 (5.4) |
Hyperlactatemia (> 2 mmol/L) | 1009 (13.8) | 46 (2.1) | 76 (7.2) | 35 (4.8) | 110 (9.4) | 742 (36.9) |
(ScvO2) > 80% | 395 (5.4) | 19 (0.9) | 25 (2.4) | 6 (0.8) | 55 (4.7) | 290 (14.4) |
Preceding 24-h trend (2) | ||||||
Improved | 1440 (19.8) | 491 (22.3) | 241 (22.8) | 170 (23.2) | 248 (21.3) | 290 (14.4) |
Deteriorated | 1,062 (14.6) | 137 (6.21) | 158 (15.0) | 86 (11.7) | 131 (11.2) | 547 (27.2) |
Unchanged | 4665 (64.0) | 1574 (71.4) | 655 (62.0) | 474 (64.8) | 788 (67.5) | 1174 (58.3) |
Expected 24-h trend (10) | ||||||
Improve | 1050 (14.4) | 376 (17.0) | 161 (15.2) | 130 (17.8) | 153 (13.1) | 230 (11.4) |
Deteriorate | 493 (6.7) | 60 (2.7) | 74 (7.0) | 30 (4.1) | 38 (3.3) | 291 (14.5) |
No change | 5542 (76.0) | 1754 (79.5) | 807 (76.4) | 565 (77.2) | 957 (82.0) | 1459 (72.5) |
Among (1) | ||||||
3 most severely ill ICU patients | 1030 (14.1) | 95 (4.3) | 112 (10.6) | 21 (2.9) | 128 (11.0) | 670 (33.3) |
3 least severely ill ICU patients | 1029 (14.1) | 649 (29.4) | 132 (12.5) | 125 (17.1) | 58 (5.0) | 58 (2.9) |
Microbiology testing | ||||||
Blood cultures | 1713 (23.5) | 404 (18.3) | 285 (27.0) | 152 (20.8) | 246 (21.1) | 607 (30.2) |
Bronchial lavage | 556 (7.63) | 65 (2.95) | 74 (7.01) | 44 (6.01) | 104 (8.91) | 262 (13.0) |
Antimicrobial therapy | 3775 (51.8) | 274 (12.4) | 238 (22.5) | 519 (70.9) | 894 (76.6) | 1789 (88.9) |