Consensus Definitions for Sepsis and Septic Shock

In 2016 a critical care task force proposed a new definition for sepsis and septic shock based on advances in science and the testing of clinical criteria against patient outcomes in EHR data.

The Task Force recommended that sepsis and septic shock be defined as follows:

  • Definitions:
    • Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection
    • Septic shock: Sepsis with circulatory and cellular/metabolic abnormalities profound enough to substantially increase mortality
  • Clinical Criteria:
    • Sepsis: Suspected or documented infection and an acute increase of ≥ 2 SOFA points (a proxy for organ dysfunction)
    • Septic Shock: Sepsis and vasopressor therapy needed to elevate MAP ≥ 65 mmg Hg and lactate > 2 mmol/L (18 mg/dL) after adequate fluid resuscitation

An accompanying editorialist reviewed what the new definitions accomplish and leave unaccomplished for our understanding of sepsis.

To learn more, browse the entire JAMA Network Sepsis and Critical Care collections.

Related Multimedia

JAMA Whiteboard: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

The JAMA Report: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock: 2016 Guideline Development Process

Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock: 2016 Recommendations for Initial Resuscitation

Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock: 2016 Management Recommendations and Differences From 2012 Guideline

Surviving Sepsis Campaign International Guidelines for Management of Sepsis and Septic Shock: Questions About 2016 Management Recommendations

Conference Presentation: Effect of Vitamin C and Thiamine on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock

Updated Guidelines for Sepsis Management

Why the New Sepsis Guideline Changed

JAMA Author Interview: Dr. Derek Angus on The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

ESICM Interview with Dr Mervyn Singer, lead author of The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

ESICM Interview with Dr Shankar-Hari, lead author of Developing a New Definition and Assessing New Clinical Criteria for Septic Shock (Part 1)

ESICM Interview with Dr Shankar-Hari, lead author of Developing a New Definition and Assessing New Clinical Criteria for Septic Shock (Part 2)

Important Sepsis Articles From the JAMA Network

Assessment of Health Care Exposures and Outcomes in Adult Patients With Sepsis and Septic Shock

Katherine Fay and Coauthors

JAMA Network Open | Original Investigation, July 7, 2020

Early-Onset Neonatal Sepsis 2015 to 2017, the Rise of Escherichia coli, and the Need for Novel Prevention Strategies

Barbara J. Stoll and Coauthors

JAMA Pediatrics | Original Investigation, May 4, 2020

Association of a Care Bundle for Early Sepsis Management With Mortality Among Patients With Hospital-Onset or Community-Onset Sepsis

Jonathan D. Baghdadi and Coauthors

JAMA Internal Medicine | Original Investigation, April 6, 2020

How Effective Is the Early Management Bundle for Severe Sepsis/Septic Shock?

Hannah Moreira and Richard Sinert

JAMA Internal Medicine | Invited Commentary, April 6, 2020

Risk Factors for Long-term Mortality and Patterns of End-of-Life Care Among Medicare Sepsis Survivors Discharged to Home Health Care

Katherine R. Courtright and Coauthors

JAMA Network Open | Original Investigation, February 26, 2020

Evaluation of the Coverage of 3 Antibiotic Regimens for Neonatal Sepsis in the Hospital Setting Across Asian Countries

Julia A. Bielicki and Coauthors

JAMA Network Open | Original Investigation, February 12, 2020

C-Reactive Protein Testing in Late-Onset Neonatal Sepsis: Hazardous Waste

Joseph B. Cantey and Charlene R. Bultmann

JAMA Pediatrics | Editorial, February 3, 2020

Is High-Dose Vitamin C Beneficial for Patients With Sepsis?

Emily B. Brant and Derek C. Angus

JAMA | Editorial, October 1, 2019

Incidence of Maternal Sepsis and Sepsis-Related Maternal Deaths in the United States

Matthew K. Hensley and Coauthors

JAMA | Research Letter, September 3, 2019

Neonatal Sepsis Evaluation: Facing the Certainty of Uncertainty

Karen M. Puopolo and Gabriel J. Escobar

JAMA Pediatrics | Editorial, September 3, 2019

Cost of Pediatric Severe Sepsis Hospitalizations

Erin F. Carlton and Coauthors

JAMA Pediatrics | Research Letter, August 12, 2019

Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis

Sachin Yende and Coauthors

JAMA Network Open | Original Investigation, August 7, 2019

Association Between State-Mandated Protocolized Sepsis Care and In-hospital Mortality Among Adults With Sepsis

Jeremy M. Kahn and Coauthors

JAMA | Original Investigation, July 16, 2019

Wide Interest in a Vitamin C Drug Cocktail for Sepsis Despite Lagging Evidence

Rita Rubin

JAMA | Medical News & Perspectives, July 3, 2019

Risk Factors at Index Hospitalization Associated With Longer-term Mortality in Adult Sepsis Survivors

Manu Shankar-Hari and Coauthors

JAMA Network Open | Original Investigation, May 31, 2019

Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis

Christopher W. Seymour and Coauthors

JAMA | Original Investigation, May 19, 2019

Reducing Collateral Damage From Mandates for Time to Antibiotics in Pediatric Sepsis—Primum Non Nocere

Luregn J. Schlapbach and Coauthors

JAMA Pediatrics | Viewpoint, March 18, 2019

How Best to Resuscitate Patients With Septic Shock?

Derek C. Angus

JAMA | Editorial, February 17, 2019

Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals

Chanu Rhee and Coauthors

JAMA Network Open | Original Investigation, February 15, 2019

A Closer Look at Sepsis-Associated Mortality

Laura Evans

JAMA Network Open | Invited Commentary, February 15, 2019

Global Case-Fatality Rates in Pediatric Severe Sepsis and Septic Shock: A Systematic Review and Meta-analysis

Bobby Tan and Coauthors

JAMA Pediatrics | Original Investigation, February 11, 2019

Association of 30-Day Mortality With Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized With Enterobacteriaceae Bacteremia

Pranita D. Tamma and Coauthors

JAMA Internal Medicine | Original Investigation, January 22, 2019

Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis: A Systematic Review and Meta-analysis

Fang Fang and Coauthors

JAMA Internal Medicine | Original Investigation, December 21, 2018

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis

Daniel J. Lane and Coauthors

JAMA Network Open | Original Investigation, December 14, 2018

Serum Creatinine in the Critically Ill Patient With Sepsis

Matthieu Legrand and John A. Kellum

JAMA | JAMA Diagnostic Test Interpretation, December 11, 2018

Artificial Intelligence Tools for Sepsis and Cancer

Jennifer Abbasi

JAMA | Biotech Innovations, December 11, 2018

Antibiotics for Sepsis—Finding the Equilibrium

Michael Klompas and Coauthors

JAMA | Viewpoint, September 14, 2018

Association Between the New York Sepsis Care Mandate and In-Hospital Mortality for Pediatric Sepsis

Idris V. R. Evans and Coauthors

JAMA | Original Investigation, July 24/31, 2018

Bundled Strategies for the Care of Children With Presumed Sepsis

Robert J. Vinci and Elliot Melendez

JAMA | Editorial, July 24/31, 2018

Defining Pediatric Sepsis

Luregn J. Schlapbach and Niranjan Kissoon

JAMA Pediatrics | Viewpoint, April 2018

Enhancing Recovery From Sepsis: A Review

Hallie C. Prescott and Derek C. Angus

JAMA | Review, January 2, 2018

Postsepsis Morbidity

Hallie C. Prescott and Derek C. Angus

JAMA | JAMA Patient Page, January 2, 2018

Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014

Chanu Rhee and Coauthors

JAMA | Original Investigation, September 13, 2017

Counting Sepsis, an Imprecise but Improving Science

Kristina E. Rudd and Coauthors

JAMA | Editorial, September 13, 2017

Epidemiology of Sepsis Among Adolescents at Community Hospital Emergency Departments: Implications for Rory’s Regulations

Idris V. R. Evans and Coauthors

JAMA Pediatrics | Research Letter, August 14, 2017

In Treating Sepsis, Questions About Timing and Mandates

Jennifer Abbasi

JAMA | Medical News & Perspectives, August 8, 2017

Association Between US Norepinephrine Shortage and Mortality Among Patients With Septic Shock

Emily Vail and Coauthors

JAMA | Original Investigation, April 11, 2017

A Quantitative, Risk-Based Approach to the Management of Neonatal Early-Onset Sepsis

Michael W. Kuzniewicz and Coauthors

JAMA Pediatrics | Original Investigation, April 2017

Association Between Early Lactate Levels and 30-Day Mortality in Clinically Suspected Sepsis in Children

Halden F. Scott and Coauthors

JAMA Pediatrics | Original Investigation, March 2017

Management of Sepsis and Septic Shock

Michael D. Howell and Andrew M. Davis

JAMA | JAMA Clinical Guidelines Synopsis, February 28, 2017

Surviving Sepsis Guidelines: A Continuous Move Toward Better Care of Patients With Sepsis

Daniel De Backer and Todd Dorman

JAMA | Viewpoint, February 28, 2017

Proportion and Cost of Unplanned 30-Day Readmissions After Sepsis Compared With Other Medical Conditions

Florian B. Mayr and Coauthors

JAMA | Research Letter, February 7, 2017

Association Between Early Lactate Levels and 30-Day Mortality in Clinically Suspected Sepsis in Children

Halden F. Scott and Coauthors

JAMA Pediatrics | Original Investigation, January 9, 2017

Act Fast and Think Sepsis

JAMA | News From the Centers for Disease Control and Prevention, October 11, 2016

Evaluating Glucocorticoids for Sepsis: Time to Change Course

Sachin Yende and B. Taylor Thompson

JAMA | Editorial, October 3, 2016

Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?

Peter Bentzer and Coauthors

JAMA | The Rational Clinical Examination, September 27, 2016

The Challenging Task of Improving the Recovery of ICU Survivors

Shannon L. Goddard and Neill K. J. Adhikari

JAMA | Editorial, June 28, 2016

Immunosuppression and Secondary Infection in Sepsis: Part, Not All, of the Story

Derek C. Angus and Steven Opal

JAMA | Editorial, March 15, 2016

Sepsis and the Global Burden of Disease in Children

Niranjan Kissoon and Timothy M. Uyeki

JAMA Pediatriacs | Viewpoint, February 2016

Assessment of a Central Line–Associated Bloodstream Infection Prevention Program in a Burn-Trauma Intensive Care Unit

Lois Remington and Coauthors

JAMA Surgery | Research Letter, December 23, 2015

Association of Intensive Care Unit Admission With Mortality Among Older Patients With Pneumonia

Thomas S. Valley and Coauthors

JAMA | Original Investigation, September 22/29, 2015

Septic Shock: Advances in Diagnosis and Treatment

Christopher W. Seymour and Matthew R. Rosengart

JAMA | Review, August 18, 2015

Readmission Diagnoses After Hospitalization for Severe Sepsis and Other Acute Medical Conditions

Hallie C. Prescott and Coauthors

JAMA | Research Letter, March 10, 2015

Lactate in Sepsis

Hernando Gomez and John A. Kellum

JAMA | JAMA Diagnostic Test Interpretation, January 13, 2015

Sepsis Mandates: Improving Inpatient Care While Advancing Quality Improvement

Colin R. Cooke and Theodore J. Iwashyna

JAMA | Viewpoint, October 8, 2014

Hospital Deaths in Patients With Sepsis From 2 Independent Cohorts

Vincent Liu and Coauthors

JAMA | Research Letter, July 2, 2014

Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand, 2000-2012

Kirsi-Maija Kaukonen and Coauthors

JAMA | Original Investigation, April 2, 2014

Declining Case Fatality Rates for Severe Sepsis: Good Data Bring Good News With Ambiguous Implications

Theodore J. Iwashyna and Derek C. Angus

JAMA | Editorial, April 2, 2014

Guideline Promotes Early, Aggressive Sepsis Treatment to Boost Survival

Bridget M. Kuehn

JAMA | Medical News and Perspectives, March 13, 2013

Serial Evaluation of the SOFA Score to Predict Outcome in Critically Ill Patients

Flavio Lopes Ferreira and Coauthors

JAMA | Caring for the Critically Ill Patient, October 10, 2001

Read more about sepsis from the JAMA Network