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December 28, 1994

Defining Sepsis-Reply

JAMA. 1994;272(24):1901. doi:10.1001/jama.1994.03520240029036

In Reply.  —As noted by Drs Knaus, Harrell, and Wagner, the APACHE III system uses a broad range of physiological variables and other risk factors that are relevant for predicting outcome in critically ill patients. With modification, the APACHE III system has been adapted for septic patients, and in population studies it can serve to stratify risk of mortality in this clinical setting.1 However, the APACHE III system does not include levels of mediators, such as cytokines or endotoxin, that have been shown to be elevated in sepsis and to correlate with outcome in severely ill septic patients.2,3 The fact that the clinical syndrome of sepsis does not have any unique single biochemical marker implies that new therapies may need to be directed to subgroups of patients with altered production or release of specific mediators. Unfortunately, the APACHE III system will not allow identification of these subgroups defined