Classification of patients with septic shock : are we there yet?

Abstract

Sepsis is a clinical syndrome that was recently redefined as lifethreatening organ dysfunction caused by a dysregulated host response to suspected infection [1]. Therefore, organ dysfunction, represented as an increase of at least 2 points in the Sequential Organ Failure Assessment (SOFA) score, is now positioned as a cornerstone of the definition. Septic shock, clinically identified by a need for vasopressor and an increased lactate level, was further defined as a major subset of sepsis in which profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. While the new definition captures the broad clinical spectrum of the syndrome, which was recently shown to better predict unfavourable outcome and to limit misclassification into low severity, there remains pronounced heterogeneity in sepsis and septic shock patients due to various types of infections, causal pathogens, comorbidities, as well as host genetics and environmental factors. This was acknowledged by experts who have asked for “a better classification of sepsis severity to avoid producing misleading guidelines and recommendations”. Thus, the question remains: how can we improve on the classification of sepsis patients in order to enable tailored therapeutic intervention and patient management?