5 Although the true incidence is unknown, conservative estimates indicate that sepsis is a leading cause of mortality and critical illness worldwide. 1 The reported incidence of sepsis is increasing, 2, 3 likely reflecting aging populations with more comorbidities, greater recognition, 4 and, in some countries, reimbursement-favorable coding. Sepsis, a syndrome of physiologic, pathologic, and biochemical abnormalities induced by infection, is a major public health concern, accounting for more than $20 billion (5.2%) of total US hospital costs in 2011. In out-of-hospital, emergency department, or general hospital ward settings, adult patients with suspected infection can be rapidly identified as being more likely to have poor outcomes typical of sepsis if they have at least 2 of the following clinical criteria that together constitute a new bedside clinical score termed quickSOFA (qSOFA): respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100 mm Hg or less. This combination is associated with hospital mortality rates greater than 40%. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%.
Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom (Singer) Hofstra–Northwell School of Medicine, Feinstein Institute for Medical Research, New Hyde Park, New York (Deutschman) Department of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (Seymour) Department of Critical Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom (Shankar-Hari) Department of Critical Care Medicine, University of Versailles, France (Annane) Center for Sepsis Control and Care, University Hospital, Jena, Germany (Bauer) Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, and Austin Hospital, Melbourne, Victoria, Australia (Bellomo) Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University, Nashville, Tennessee (Bernard) Reanimation Medicale-Hopital Cochin, Descartes University, Cochin Institute, Paris, France (Chiche) Critical Care Center, Emory University School of Medicine, Atlanta, Georgia (Coopersmith) Washington University School of Medicine, St Louis, Missouri (Hotchkiss) Infectious Disease Section, Division of Pulmonary and Critical Care Medicine, Brown University School of Medicine, Providence, Rhode Island (Levy, Opal) Department of Surgery, University of Toronto, Toronto, Ontario, Canada (Marshall) Emory University School of Medicine and Grady Memorial Hospital, Atlanta, Georgia (Martin) Trauma, Emergency & Critical Care Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (Rubenfeld) Interdepartmental Division of Critical Care, University of Toronto (Rubenfeld) Department of Infectious Diseases, Academisch Medisch Centrum, Amsterdam, the Netherlands (van der Poll) Department of Intensive Care, Erasme University Hospital, Brussels, Belgium (Vincent) Department of Critical Care Medicine, University of Pittsburgh and UPMC Health System, Pittsburgh, Pennsylvania (Angus) Associate Editor, JAMA (Angus).