Definition of sepsis and septic shock

Summary

Objective:

to describe development of sepsis and septic shock definition over the time.

Design:

literature review. Material and methods: evaluation of the sepsis understanding over the time based on published articles.

Results:

first scientific definition of sepsis was published in 1914. The definition described sepsis as bacterial infection spreading to the blood stream and giving rise to metastatic infections. This definition was significantly changed in 1989, when new nosological unit – systemic inflammatory response syndrome (SIRS) – was introduced in clinical medicine. In 1992 sepsis was defined as presence of SIRS with infection (currently, the definition is named Sepsis-1). Another slight change of sepsis definition was done in 2001, when beside other important biomarkers such C- reactive protein, procalcitonin and lactate were added (currently, the definition is named Sepsis-2). In 2016 another sepsis definition was accepted; the definition is covering a wide scale of clinical situations and is named Sepsis-3. The presence of SIRS is not now necessary for sepsis diagnosis, but the most important feature is organ failure, which is equivalent to term severe sepsis in Sepsis-1 and Sepsis-2 definitions. Evolution of the definition is reflecting improvement of knowledge of sepsis and septic shock pathophysiology, which is necessary condition for development of new diagnostic and therapeutic approaches.

Conclusion:

importance of organ failure in Sepsis-3 definition has significantly shifted sepsis to intensive care medicine. New insights are important for early detection of sepsis cases in prehospital, emergency and standard care settings.

Keywords:

Sepsis; SIRS; definition; Sepsis-3