Developing a New Definition and Assessing New Clinical Criteria for Septic Shock

作者：Manu Shankar‐Hari, Gary S. Phillips, Mitchell L. Levy, Christopher W. Seymour, Vincent X. Liu, Clifford Scott Deutschman, Derek C. Angus, Gordon David Rubenfeld, Mervyn Singer, for the Sepsis Definitions Task Force · 发表于：JAMA · 年份：2016 · DOI：10.1001/jama.2016.0289 · 被引用次数：2509 · 研究领域：Sepsis Diagnosis and Treatment、Immune Response and Inflammation、Hemodynamic Monitoring and Therapy

IMPORTANCE: Septic shock currently refers to a state of acute circulatory failure associated with infection. Emerging biological insights and reported variation in epidemiology challenge the validity of this definition. OBJECTIVE: To develop a new definition and clinical criteria for identifying septic shock in adults. DESIGN, SETTING, AND PARTICIPANTS: The Society of Critical Care Medicine and the European Society of Intensive Care Medicine convened a task force (19 participants) to revise current sepsis/septic shock definitions. Three sets of studies were conducted: (1) a systematic review and meta-analysis of observational studies in adults published between January 1, 1992, and December 25, 2015, to determine clinical criteria currently reported to identify septic shock and inform the Delphi process; (2) a Delphi study among the task force comprising 3 surveys and discussions of results from the systematic review, surveys, and cohort studies to achieve consensus on a new septic shock definition and clinical criteria; and (3) cohort studies to test variables identified by the Delphi process using Surviving Sepsis Campaign (SSC) (2005-2010; n = 28,150), University of Pittsburgh Medical Center (UPMC) (2010-2012; n = 1,309,025), and Kaiser Permanente Northern California (KPNC) (2009-2013; n = 1,847,165) electronic health record (EHR) data sets. MAIN OUTCOMES AND MEASURES: Evidence for and agreement on septic shock definitions and criteria. RESULTS: The systematic review ident...