Sepse: uma discussão sobre as mudanças de seus critérios diagnósticos / Sepse: a discussion on the changes of its diagnostic criteria
Keywords:
Sepse. qSOFA. SOFA. SIRS. Mortalidade. Sensibilidade.Abstract
No início de 2016 ocorreu o Terceiro Consenso Internacional para a Definição de Sepse e Choque Séptico (Sepsis-3), no qual algumas mudanças foram adotadas em relação aos antigos critérios diagnósticos, e com elas surgiram dúvidas e discussões a respeito de suas adequações, vantagens e desvantagens. Para melhor esclarecimento destas questões realizamos esta revisão da literatura, cujos resultados indicaram que as atualizações das definições de sepse trazem vantagens em relação ao entendimento de sua definição e fisiopatologia, além de trazer maior importância a qualquer quadro de sepse. Entretanto, o novo escore ainda apresenta problemas como: dificuldade do uso, retardo do diagnóstico, ausência de validação prospectiva do Quick Sequential Organ Failure Assessment (qSOFA), diminuição da importância do lactato e redução da sensibilidade. Desse modo, os critérios de Systemic Inflammatory Response Syndrome (SIRS) ainda não podem ser totalmente abandonados, principalmente nos países em desenvolvimento. Além disso, ainda é necessária a realização de mais estudos prospectivos sobre o assunto e que levem em consideração dados de países em desenvolvimento, como mortalidade, recursos e epidemiologia.
References
Machado Flavia Ribeiro, Assunção Murillo Santucci Cesar de, Cavalcanti Alexandre Biasi, Japiassú André Miguel, Azevedo Luciano Cesar Pontes de, Oliveira Mirella Cristine. Chegando a um consenso: vantagens e desvantagens do Sepsis 3 considerando países de recursos limitados. Rev. bras. ter. intensiva. 2016 Dec; 28( 4 ): 361-365.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10
Shankar-Hari M, Phillips GS, Levy ML, Seymour CW, Liu VX, Deutschman CS, Angus DC, Rubenfeld GD, Singer M; Sepsis Definitions Task Force. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):775-87.
Vincent, Jean-Louis et al. Sepsis definitions: time for change. The Lancet. 2013; Volume 381 , Issue 9868 , 774 – 775
Hotchkiss RS, Monneret G, Payen D. Sepsis-induced immunosuppression: from cellular dysfunctions to immunotherapy. Nat Rev Immunol. 2013;13(12):862-74
Instituto Latino Americano de Sepse (ILAS). Propostas De Mudanças Relatório Ilas. 2016. Disponível em: <http://ilas.org.br/assets/arquivos/upload/declaracao sepse 3.0 ILAS.pdf>. Acesso em: 24 de Maio de 2017
Siqueira-Batista Rodrigo, Mendonça Eduardo Gomes de, Gomes Andréia Patrícia, Vitorino Rodrigo Roger, Miyadahira Renato, Alvarez-Perez Mario Castro et al . Atualidades proteômicas na sepse. Rev. Assoc. Med. Bras. 2012 June; 58( 3 ): 376-382
Perez, Mario Castro Alvarez. Epidemiologia, diagnóstico, marcadores de imunocompetência e prognostico da sepse [tese]. Rio de Janeiro: Universidade do Estado do Rio de Janeiro; 2009
Perez, Mario Castro Alvarez. Discussão sobre sepse: SIRS x SOFA. Rio de Janeiro, UERJ, 07 fev. 2017. Entrevista realizada por acadêmicos no website PEBMED.
ILAS. SPREAD - Sepsis Prevalence Assessment Database. The Lancet Infectious Diseases. No prelo 2012. Disponível em: <http://www.ilas.org.br/spread.php>. Acesso em: 25 de Maio de 2017.
Assunção, Murillo et al. Survey on physicians' knowledge of sepsis: Do they recognize it promptly?. Journal Of Critical Care.dez. 2010; v. 25, n. 4, p.545-552. Elsevier BV.
Kaukonen K-M, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic Inflammatory Response Syndrome Criteria in Defining Severe Sepsis. New England Journal of Medicine. 2015;372(17):1629-1638.
Vincent JL, Martin GS, Levy MM. qSOFA does not replace SIRS in the definition of sepsis. Crit Care. 2016;20(1):210
Vincent J-L, Grimaldi D. Quick sequential organ failure assessment: big databases vs. intelligent doctors. Journal of Thoracic Disease. 2016;8(9):E996-E998. doi:10.21037/jtd.2016.07.78.
Giamarellos-Bourboulis EJ, Tsaganos T, Tsangaris I, Lada M, Routsi C, Sinapidis D et al. [Hellenic Sepsis Study Group]. Validation of the new sepsis-3 definitions: proposal for improvement in early risk identification. Clin Microbiol Infect. 2016 Nov 14; pii: S1198-743X(16)30558-4.
Williams JM, Greenslade JH, McKenzie JV, Chu K, Brown AF, Lipman J. SIRS, qSOFA and organ dysfunction: insights from a prospective database of emergency department patients with infection. Chest. 2016 Nov 19; pii: S0012-3692(16)62359-0.
Churpek MM, Zadravecz FJ, Winslow C, Howell MD, Edelson DP. Incidence and Prognostic Value of the Systemic Inflammatory Response Syndrome and Organ Dysfunctions in Ward Patients. Am J Respir Crit Care Med. 2015;192(8):958-64
Lamontagne F, Harrison DA, Rowan KM. qSOFA for Identifying Sepsis Among Patients With Infection. JAMA.2017;317(3):267-268. doi:10.1001/jama.2016.19684
Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R et al.[The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE)]. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. JAMA. 2017;317(3):290-300. doi:10.1001/jama.2016.20328
Julian M. Williams, M. C. I. A. T. A. M. J. M. W. E. T. A. M. J. M. W., Jaimi H. Greenslade, PHD et al. Systemic Inflammatory Response Syndrome, Quick Sequential Organ Function Assessment, and Organ Dysfunction. Insights From a Prospective Database of ED Patients With Infection: 2017. Pages 586 - 596 p
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. doi:10.1001/jama.2016.0288.
Ferrer R, Artigas A, Suarez D, et al; Edusepsis Study Group: Effectiveness of treatments for severe sepsis: A prospective, multicenter, observational study. Am J Respir Crit Care Med.2009; 180:861–866
Kumar A, Roberts D, Wood KE, et al: Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med.2006; 34:1589–1596
Ferrer R, Martin-Loeches I, Phillips G, et al: Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: Results from a guideline-based performance improvement program. Crit Care Med2014; 42:1749–1755
Zhang D, Micek ST, Kollef MH: Time to appropriate antibiotic therapy is an independent determinant of postinfection ICU and hospital lengths of stay in patients with sepsis. Crit Care Med.2015; 43:2133–2140
de Groot B, Ansems A, Gerling DH, et al: The association between time to antibiotics and relevant clinical outcomes in emergency department patients with various stages of sepsis: A prospective multi-center study. Crit Care.2015; 19:194
Barie PS, Hydo LJ, Shou J, et al: Influence of antibiotic therapy on mortality of critical surgical illness caused or complicated by infection. Surg Infect (Larchmt).2005; 6:41–54
Gaieski DF, Mikkelsen ME, Band RA, et al: Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med.2010; 38:1045–1053
Kumar A: Systematic bias in meta-analyses of time to antimicrobial in sepsis studies. Crit Care Med.2016; 44:e234–e235
Sterling, Sarah A. et al. The Impact of Timing of Antibiotics on Outcomes in Severe Sepsis and Septic Shock. Critical Care Medicine.set 2015. v. 43, n. 9, p.1907-1915. Ovid Technologies (Wolters Kluwer Health).
Levy MM, Dellinger RP, Townsend SR, Linde-Zwirble WT, Marshall JC, Bion J, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Intensive Care Med. 2010;36(2):222-31.
Westphal, Glauco Adrieno; Lino, Adriana Silva. Systematic screening is essential for early diagnosis of severe sepsis and septic shock. Revista Brasileira de Terapia Intensiva. 2015;v. 27, n. 2, p.96-101. GN1 Genesis Network
Dias Monica Aguilar Estevam, Martins Monica, Navarro Nair. Rastreamento de resultados adversos nas internações do Sistema Único de Saúde. Rev. Saúde Pública. 2012 Aug; 46( 4 ): 719-729.
Machado FR, Cavalcanti AB, Carrara FS, Bozza FA, Lubarino J, Azevedo LC, et al. Prevalência e mortalidade por sepse grave e choque séptico em unidades de terapia intensiva brasileiras. Rev Bras Terapia Intensiva. 2014;Supl 1:S13.
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. doi:10.1001/jama.2016.0288.
ABRAHAM, Edward. New Definitions for Sepsis and Septic Shock: Continuing Evolution but With Much Still to Be Done. JAMA; 23 fev. 2016. v. 315, n. 8, p.757-759.
Rhee, C.; Klompas, M. New Sepsis and Septic Shock Definitions: Clinical Implications and Controversies. Infect Dis Clin North Am, Jul 2017; ISSN 1557-9824. Disponível em: <https://www.ncbi.nlm.nih.gov/pubmed/28687209> Acesso em: 3 de Julho de 2017
Jones AEM, Puskarich MAM. Is lactate the “Holy Grail” of biomarkers for sepsis prognosis? Critical Care Medicine. 2009;37(5):1812 - 1813.
Ranzani Otavio Tavares, Monteiro Mariana Barbosa, Ferreira Elaine Maria, Santos Sergio Ricardo, Machado Flavia Ribeiro, Noritomi Danilo Teixeira. Reclassificando o espectro de pacientes septicos com o uso do lactato: sepse grave, choque criptico, choque vasoplegico e choque disoxico. Rev. bras. ter. Intensive. Dec 2013; 25( 4 ): 270-278.
Surviving Sepsis Campaign. The Surviving Sepsis Campaign responds to Sepsis-3. 2016. Disponível em :<http://www.survivingsepsis.org/SiteCollectionDocuments/SSCStatements-Sepsis-Definitions-3-2016.pdf.> Acesso em: 5 de Julho de 2017