International Clinical Pathology Journal The Evolving Definition of Sepsis Submit Manuscript | http://medcraveonline.com Volume 2 Issue 6 - 2016 ¹Office of Research, Middle Tennessee State University, USA 2 WPC Healthcare, USA 3 Vanderbilt University Medical Center, USA 4 College of Computing and Technology, Lipscomb University, USA *Corresponding author: Damian Mingle, Chief Data Scientist at WPC Healthcare 1802 Williamson Court, Brentwood, Tennessee, USA, Email: Received: September 20, 2016 | Published: October 19, 2016 Review Article Int Clin Pathol J 2016, 2(6): 00063 Abstract Sepsis affects millions of people worldwide each year. It occurs when a normal human immune response to a bacterial, viral or fungal infection becomes dysfunctional and triggers widespread inflammation that results in severe tissue damage that leads to organ failure, shock, and death. Sepsis requires immediate treatment and has a high readmission rate for survivors. It is also one of the most expensive conditions to treat. In 2013, there were more than 1.6 million cases of sepsis in the United States with a financial cost of more than $23 billion. Sepsis was first described in antiquity, and given its current name, by the ancient Greek physician Hippocrates. Despite its long medical history, severity, and financial burden, the causes of sepsis are not well understood, and there is no standard approach to diagnosis and treatment. The definition of sepsis, the characterization of its clinical stages, and sepsis monitoring tools have changed three times in the past 25 years, most recently in March 2016. The universal adoption of this latest definition, sepsis-3, and a screening tool, qSOFA, are currently under debate in the medical community. A means to rapidly identify and treat sepsis could reduce the five million deaths due to sepsis each year worldwide. This paper reviews the evolution of the definition of sepsis and the controversy surrounding the sepsis-3 definition and the sepsis screening tool, qSOFA. Keywords: Sepsis; Septic shock; Severe sepsis; SIRS; Critical care; Electronic healthcare records; Sepsis-3; qSOFA Abbreviations: APACHE: Acute Physiology and Chronic Health Evaluation; EWS: Early Warning Score; HUCP: The Healthcare Cost and Utilization Project; ICU: Intensive Care Unit; MEDS: Mortality in Emergency Department Sepsis; MEWS: Modified Early Warning System; MIMIC: Medical Information Mart for Intensive Care; PIRO: Predisposition, Infection, Response to the infectious challenge, and Organ dysfunction; qSOFA: quick Sepsis- related Organ Failure Assessment; S)RS: Systemic )nflammatory Response Syndrome; SOFA: the Sepsis-related Organ Failure Assessment; Running Title: The Evolving Definition of Sepsis Introduction Sepsis is one of the oldest, costliest, and most devastating medical conditions in the world. Sepsis was first described in ancient Egypt almost 5,000 years ago and given its current name by the Greek physician Hippocrates about 2,400 years ago [ͳ]. )n ʹͲͳ͵, the annual financial burden of sepsis in the United States was more than $23 billion. Despite its long history and its current impact on society, sepsis as a medical condition is not well understood. The definition is under current revision [ʹ-ͷ] there is no gold standard diagnostic test for sepsis, nor is there a universally adopted treatment [6]. Along with revising the definition, there has been a search for the best screening tool to identify sepsis. A medical task force utilized the recent availability of large datasets of patients to compare and validate several screening tools for sepsis. These tools were used to explore more than one million patient electronic healthcare records (EHR) with a known number of patients with sepsis [7]. The use of a data science approach to validating a screening tool for sepsis is a promising area of research. In this paper we describe the severity of sepsis, its evolving definition, and the screen tool, qSOFA. he Severity of Sepsis Sepsis is a significant cause of healthcare costs and mortality rates. Worldwide, an estimated 31.5 million people are treated each year for sepsis of which 5.3 million end up dying from sepsis [8]. In the United States, there are about 1.6 million cases of sepsis each year with more than 258,000 deaths, which averages to one person dying of sepsis every two minutes [ͻ]. The financial cost of treating sepsis is staggering. The 2015 Healthcare Cost and Utilization Project (HUCP) Statistical Brief places sepsis as the most expensive condition treated in US hospitals at $23.7 billion [10]. Sepsis accounts for 40 percent of all ICU costs in the United States, and the average cost for treatment of ICU patients with sepsis is six times greater than that for ICU patients that do not have sepsis. Additionally, patients discharged after a serious bout of sepsis have a 62 percent readmission rate [11,12]. This information on the severity of sepsis is summarized in Table 1. Table ͳ: Notable facts about sepsis. Notable Details High cost to treat Most expensive condition treated in the United States: $23.7B High ICU costs 40% of all ICU costs High mortality rate 60% for septic shock High readmission rate 62% Rapid decline Move to septic shock within 36 hours of identification Challenging No standard diagnostic test, often appears with co morbid conditions