Utfordringer ved tidlig sepsisdiagnostikk - Styrker og svakheter ved SIRS

Abstract

Background: Sepsis increases in incidence and is one of the most common causes of death in hospitalized patients. Early diagnosis is a particular challenge, thus we wanted to examine the diagnostic accuracy of the SIRS criteria and the definition as presented by the Surviving Sepsis Campaign (SSC) in 2013 and see how they correspond with the clinicians understanding of the disease state. Material and method: A combined prospective and retrospective observational study was performed based on patients admitted to the ICU at Oslo University Hospital, Ullevål during December 2013. The ability of the two definitions to differentiate between patients with adjudicated sepsis, infection without sepsis and non-infectious disease was assessed through non-parametric tests and using receiver operating characteristic (ROC) analysis. Results and discussion: 92 patients were included to the study. The median age was 66 years, 24% died within the first 30 days. 25% of the patients had adjudicated sepsis, severe sepsis or septic shock, 28% had infection without sepsis and 46% had a non-infectious disease. Use of the SIRS criteria in the ER was not able to differentiate between patients with adjudicated sepsis and infection without sepsis in contrast to the SSC definition which did this (p < 0.0001). Conclusion: Our data suggest that the SSC definition corresponds better with the clinicians understanding of sepsis and is more specific than the SIRS criteria of 1991. However, the criteria of the SSC definition are more cumbersome to use than SIRS. With further modifications they may be better suited for the diagnosis of sepsis.

Background: Sepsis increases in incidence and is one of the most common causes of death in hospitalized patients. Early diagnosis is a particular challenge, thus we wanted to examine the diagnostic accuracy of the SIRS criteria and the definition as presented by the Surviving Sepsis Campaign (SSC) in 2013 and see how they correspond with the clinicians understanding of the disease state.