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Comment & Response
July 26, 2016

Definitions for Sepsis and Septic Shock—Reply

Author Affiliations
  • 1Center for Pediatric Research, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
  • 2Bloomsburg Institute of Intensive Care Medicine, University College London, London, United Kingdom
JAMA. 2016;316(4):458-459. doi:10.1001/jama.2016.6389

In Reply Drs Sprung and Reinhart and Dr Schneider-Lindner and colleagues believe that Sepsis-3 recommends abandoning SIRS. That is not the case. Rather, SIRS may be useful in the presumptive diagnosis of infection. However, SIRS is not specific nor particularly sensitive for infection. As an example, Churpek and colleagues1 reported that 50% of hospital inpatients have SIRS at least once in their hospital stay, and many of these patients will not have infection nor require antibiotic therapy. Conversely, 64% of the 66 522 non–intensive care unit (ICU) patients in the University of Pittsburgh Medical Center validation cohort had 0 or 1 SIRS criteria at the time they were cultured and treated for suspected infection. The article also did not suggest that what was previously called “sepsis” be eliminated from the diagnostic spectrum. Rather, it should be simply and correctly identified as “infection.”

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