The future of sepsis research: time to think differently?

Unpacking the sepsis controversy

Despite its many definitions and revisions, consensus statements and clinical guidelines, the term 'sepsis' continues to be referred to as a discrete clinical entity that is often claimed to be a direct cause of mortality. The assertion that sepsis can be defined as a 'life-threatening organ dysfunction caused by a dysregulated host response to infection,' has led to a field dominated by failed clinical trials informed by host-centered, pathogen-agnostic, animal experiments in which animal models do not recapitulate the clinical condition. The observations from the National Health Service from England that claim that 77.5% of sepsis deaths occur in those aged 75 years or older and those from the USA indicating that most patients dying of sepsis have also been diagnosed with 'hospice qualifying conditions,' seem to refute the assertion that sepsis is caused by, rather than associated with, a 'dysregulated host response.' This piece challenges the current conceptual framework that forms the basis of the sepsis definition. Here we posit that as a result of both its definition and the use of inappropriate animal models, ineffective clinical treatments continue to be pursued in this field.

A 2-year retrospective analysis of the prognostic value of MqSOFA compared to lactate, NEWS and qSOFA in patients with sepsis

Purpose

Sepsis is a life-threating organ dysfunction caused by a dysregulated host response to infection. Being a time-dependent condition, the present study aims to compare a recently established score, i.e., modified quick SOFA (MqSOFA), with other existing tools commonly applied to predict in-hospital mortality.

Methods

All cases of sepsis and septic shock consecutively observed at St. Anna University Hospital of Ferrara, Italy, from January 2017 to December 2018 were included in this study. Each patient was evaluated with MqSOFA, lactate assay, NEWS and qSOFA. Accurate statistical and logistic regression analyses were applied to our database.

Results

A total of 1001 consecutive patients with sepsis/septic shock were retrieved. Among them, 444 were excluded for incomplete details about vital parameters; thus, 556 patients were eligible for the study. Data analysis showed that MqSOFA, NEWS and lactate assay provided a better predictive ability than qSOFA in terms of in-hospital mortality (p < 0.001). Aetiology-based stratification in 5 subgroups demonstrated the superiority of NEWS vs. other tools in predicting fatal outcomes (p = 0.030 respiratory, p = 0.036 urinary, p = 0.044 abdominal, p = 0.047 miscellaneous and p = 0.041 for indeterminate causes). After Bonferroni’s correction, MqSOFA was superior to qSOFA over respiratory (p < 0.001) and urinary (p < 0.001) aetiologies. Age was an independent factor for negative outcomes (p < 0.001).

Conclusions

MqSOFA, NEWS and lactate assay better predicted in-hospital mortality compared to qSOFA. Since sepsis needs a time-dependent assessment, an easier and non-invasive score, i.e., MqSOFA, could be used to establish patients’ outcome in the emergency setting.