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.

Validating the Sepsis Definition

Assessment of Clinical Criteria for Sepsis

Evaluating the Validity of Sepsis-3 Criteria in the Emergency Department

Prognostic Accuracy of SIRS Criteria and SOFA and qSOFA Scores Among ICU Patients With Suspected Infection

Pediatric SOFA Score Validation and Sepsis-3 Assessment in Critically Ill Children

Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries

Validating the Septic Shock Definition

New Definition and Criteria for Septic Shock

Editorials

New Definitions for Sepsis and Septic Shock

qSOFA for Identifying Sepsis Among Patients With Infection

Surviving Sepsis Guidelines

qSOFA Score for Patients With Sepsis in Low- and Middle-Income Countries

Related Resources

SOFA Score

qSOFA score

Diagnostic Algorithm

Guidelines Synopsis: Management of Sepsis and Septic Shock

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)

JAMA Author Interview with Clifford Deutschman, MD, MS, Mervyn Singer, MD and Derek Angus, MD, MPH

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

Prevalence of Antibiotic-Resistant Pathogens in Culture-Proven Sepsis and Outcomes Associated With Inadequate and Broad-Spectrum Empiric Antibiotic Use

Chanu Rhee and Coauthors

JAMA Network Open | Original Investigation, April 16, 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

Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory Hypotension: A Randomized Clinical Trial

François Lamontagne and Coauthors

JAMA | Original Investigation, February 12, 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

Effect of Vancomycin or Daptomycin With vs Without an Antistaphylococcal β-Lactam on Mortality, Bacteremia, Relapse, or Treatment Failure in Patients With MRSA Bacteremia: A Randomized Clinical Trial

Steven Y. C. Tong and Coauthors

JAMA | Original Investigation, February 11, 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

Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial

Tomoko Fujii and Coauthors

JAMA | Preliminary Communication, January 17, 2020

Lack of Benefit of High-Dose Vitamin C, Thiamine, and Hydrocortisone Combination for Patients With Sepsis

Andre C. Kalil

JAMA | Editorial, January 17, 2020

Differences in Central Line–Associated Bloodstream Infection Rates Based on the Criteria Used to Count Central Line Days

David Scheinker and Coauthors

JAMA | Research Letter, January 14, 2020

Evaluation of Plasma Microbial Cell-Free DNA Sequencing to Predict Bloodstream Infection in Pediatric Patients With Relapsed or Refractory Cancer

Kathryn P. Goggin and Coauthors

JAMA Oncology | Brief Report, December 19, 2019

Effect of Selepressin vs Placebo on Ventilator- and Vasopressor-Free Days in Patients With Septic Shock: The SEPSIS-ACT Randomized Clinical Trial

Pierre-Francois Laterre and Coauthors

JAMA | Original Investigation, October 2, 2019

Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial

Alpha A. Fowler III and Coauthors

JAMA | Preliminary Communication, October 1, 2019

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

Association of Use of the Neonatal Early-Onset Sepsis Calculator With Reduction in Antibiotic Therapy and Safety: A Systematic Review and Meta-analysis

Niek B. Achten and Coauthors

JAMA Pediatrics | Original Investigation, September 3, 2019

New Phenotypes for Sepsis: The Promise and Problem of Applying Machine Learning and Artificial Intelligence in Clinical Research

William A. Knaus and Richard D. Marks

JAMA | Editorial, May 19, 2019

Effect of a Recombinant Human Soluble Thrombomodulin on Mortality in Patients With Sepsis-Associated Coagulopathy: The SCARLET Randomized Clinical Trial

Jean-Louis Vincent and Coauthors

JAMA | Original Investigation, May 19, 2019

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

Christopher W. Seymour and Coauthors

JAMA | Original Investigation, May 19, 2019

Prevalence of Bacteremia and Bacterial Meningitis in Febrile Neonates and Infants in the Second Month of Life: A Systematic Review and Meta-analysis

Eric A. Biondi and Coauthors

JAMA Network Open | Original Investigation, March 22, 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

Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial

Glenn Hernández and Coauthors

JAMA | Original Investigation, February 17, 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

Effect of Levocarnitine vs Placebo as an Adjunctive Treatment for Septic Shock: The Rapid Administration of Carnitine in Sepsis (RACE) Randomized Clinical Trial

Alan E. Jones and Coauthors

JAMA Network Open | Original Investigation, December 21, 2018

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

Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries

Kristina E. Rudd and Coauthors

JAMA | Original Investigation, June 5, 2018

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

Economic Evaluation of Quality Improvement Interventions for Bloodstream Infections Related to Central Catheters: A Systematic Review

Teryl K. Nuckols and Coauthors

JAMA Pediatrics | Review, December 2016

Act Fast and Think Sepsis

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

Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis: The HYPRESS Randomized Clinical Trial

Didier Keh and Coauthors

JAMA | Original Investigation, October 3, 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

Practice Patterns and Outcomes Associated With Use of Anticoagulation Among Patients With Atrial Fibrillation During Sepsis

Allan J. Walkey and Coauthors

JAMA | Original Investigation, September 2016

Effect of Sodium Selenite Administration and Procalcitonin-Guided Therapy on Mortality in Patients With Severe Sepsis or Septic Shock: A Randomized Clinical Trial

Frank Bloos and Coauthors

JAMA Internal Medicine | Original Investigation, July 18, 2016

Effect of a Primary Care Management Intervention on Mental Health–Related Quality of Life Among Survivors of Sepsis: A Randomized Clinical Trial

Konrad Schmidt and Coauthors

JAMA | Original Investigation, June 28, 2016

Standardized Rehabilitation and Hospital Length of Stay Among Patients With Acute Respiratory Failure: A Randomized Clinical Trial

Peter E. Morris and Coauthors

JAMA | Original Investigation, June 28, 2016

The Challenging Task of Improving the Recovery of ICU Survivors

Shannon L. Goddard and Neill K. J. Adhikari

JAMA | Editorial, June 28, 2016

Incidence, Risk Factors, and Attributable Mortality of Secondary Infections in the Intensive Care Unit After Admission for Sepsis

Lonneke A. van Vught and Coauthors

JAMA | Original Investigation, March 15, 2016

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

Effect of Empirical Treatment With Moxifloxacin and Meropenem vs Meropenem on Sepsis-Related Organ Dysfunction in Patients With Severe Sepsis: A Randomized Trial

Frank M. Brunkhorst and Coauthors

JAMA | Original Contribution, June 13, 2012

Management of Sepsis: A 47-Year-Old Woman With an Indwelling Intravenous Catheter and Sepsis

Derek C. Angus

JAMA | Clinical Crossroads, April 13, 2011

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