Table 2.

Examples of alternative sepsis diagnostic criteria by purpose.

Purpose		Objective	Example	Criteria	Caveats
Clinical care		To inform the direct clinical care of sepsis at the bedside	ESICM/SCCM Third International Consensus Definitions for Sepsis and Septic Shock Task Force*7	Among patients in whom the clinician suspects infection: Acute change in SOFA score >2 points (if baseline available) For clinical prompt in infected patients: >2 qSOFA points outside the ICU	Sepsis not restricted to confirmed infection, but rather those with infection as determined clinically Organ dysfunction proposed to be causally related to infection, but often difficult to ascertain No criteria proposed for infection, left to clinician judgment SOFA score baseline may not always be available, difficult to assess change qSOFA score captures may of those most likely to be septic, but requires prospective validation
Research	Clinical	To guide the conduct of clinical research in sepsis, including experimental and observational research	Enrollment criteria for the ACCESS trial34	Among patients with evidence of infection, all of: 3 or more SIRS criteria 1 major organ dysfunction High risk of death determined by APACHE II score (21 to 37 points)	Broad variety in clinical research criteria, and observational studies may not agree with randomized clinical trials Enrollment in clinical trials will focus on objective criteria to improve reliability Subsets of patients are often selected to reduce heterogeneity of treatment effects
	Basic	To guide the study of the fundamental principles of sepsis, often in animal models	Murine sepsis score after fecal-induced peritonis35	Score ranging from 0 to 28, with 4 points for: Appearance Level of consciousness Activity Response to stimulus Eyes Respiration rate Respiration quality	Reported with high inter-rater, test-retest reliability May be specific to the type of animal model used in experiments Alternative models using wireless biotelemetry and clinical data are under study
Surveillance and epidemiology		To track local and national burden, incidence and outcomes of sepsis across hospitals and over time	CDC Prevention Epicenters Preliminary criteria32	Among patients with infection, >1 of: vasopressor use >2 days of mechanical ventilation rise in serum creatinine by >0.5	Avoids data elements not readily available in the electronic health record such as vital signs in order to improve feasibility in wider array of facilities For similar patients, clinicians may provide organ support differently
QI and audit		To inform quality improvement initiatives and audit performance across hospitals	CMS22	ICD9-10-CM claims based algorithm to find denominator of sepsis patients Manual chart review for SIRS criteria and organ dysfunction criteria to narrow cases	Restricts to cohort of patients identified with administrative data May result in a smaller subset of patients

^*Task Force articulated the overarching definition for sepsis as Infection complicated by acute, life-threatening organ dysfunction due to a dysregulated host response