PERFORMANCE OF THE SEPSIS‑3 DEFINITIONS IN A MIDDLE INCOME COUNTRY INTENSIVE CARE UNIT

Abstract

Background: Since the first publication, of 2016, Sepsis-3 definitions have not been universally accepted, rather, they have become a source of controversy. Because clinical and laboratory parameters used had been derived mainly from patients hospitalized in United States’ Intensive Care Units (ICU).

Purpose: the aim of this study was to evaluate the performance of the Sepsis‑3 definitions for the prediction of ICU-mortality in a Tunisian ICU population as compared to 2003 Consensus Definitions (Sepsis-2 definitions)

Methods: It was a retrospective study conducted in an 18-bed medical surgical intensive care unit at the military hospital of Tunis (Tunisia).  From January 2012 to January 2016, all patients admitted to the ICU for sepsis, severe sepsis or septic shock as defined according to 2003 Consensus Definitions (Sepsis-2 consensus) were eligible for this study. The new Sepsis-3 definition was secondly used to classify included patients. The primary area of interest was ICU mortality defined as death before ICU discharge

Results: A total of 1080 patients were included during the recruitment period. . When the Sepsis-2 definitions were used there had been a difference in mortality only between septic shock and sepsis patients. While Sepsis-3 definitions show that mortality increased from 16 % among no-dysfunction-infected patients to 30 % among patients with qSOFA ≥ 2 and 44% or 46% for sepsis or septic shock patients, respectively.

Conclusions: Sepsis-3 was better than sepsis-2 definitions at stratifying mortality among septic patients admitted to an ICU of a middle income country (Tunisia).