Talk:Sepsis/Archive 1

Archive 1

Archive 2

Septic

Is there a reason why Septic is a redirect to Sepsis? I don't quite understand it from the article text. --Timc 03:22, 6 Jun 2004 (UTC)

I believe septic is a term used to describe someone or something with sepsis. Vansice 23:15, 2 June 2006 (UTC)

"Septic" is the adjective of "sepsis". JFW | T@lk 10:52, 4 November 2012 (UTC)

Can sepsis not also mean infection generally>? I also point out the naming of antiseptic class of drugs...many of these would not treat sepsis as defined in this article, and used to treat/prevent minor infections. Perhaps a sentence mentioning this more widely scoped use of the word in the lead might be in order. lesion (talk) 10:59, 10 January 2013 (UTC)

Post-sepsis

I can't find anything related to what happens to babies born with sepsis, I was born with sepsis, and I turned out to be a very withdrawn child who was very afraid of people. --86.18.156.77 16:28, 25 December 2006 (UTC)

I am not sure if your psychological development is related to having sepsis as a baby. What makes you think you turned out this way for that reason? Grim Faerie (talk) 14:05, 31 January 2008 (UTC)

Abdomenal GSWs and sepsis

I think the article should mention the high incidence of sepsis following gunshot wounds to the abdomen. My understanding is that this is caused by wholesale leaking of GI material from punctured (or eviscerated) bowel and colon into the abdominal cavity, and that left unchecked death from massive sepsis can occur with 24-36 hours. This article discusses GSWs in Lagos (where prompt surgery and antibiotics clearly aren't always available). Also, I understand a large number of battlefield deaths in WW1 (particularly at the beginning, before they figured out surgical methods for treating abdominal injuries) were due to gunshot-related sepsis. -- Finlay McWalter | Talk 00:53, 19 Aug 2004 (UTC)

Septicemia

Could someone who knows about septicemia please make a separate article instead of a redirect?

Please sign your name. Septicicaemia is a form of sepsis, and creating a seperate page would lead to Balkanisation of the relevant information. Just keep it here. JFW | T@lk 07:08, 15 Jun 2005 (UTC)

Question

My 2 month pregnant, 26 year old friend died last week. It started 3 weeks ago with up and down fever and head pain.After one week in the hospital she could not speak any more and a week later she died. The death certificate announce: SEPTICEMIA, UTI, MAJOR DEPRESSIVE MOOD WITH PHYCITOSIS. Can a young person like her die that fast from it? Tom Philippines April.06

Toxic shock syndrome which is a very aggressive condition, can be fatal within 24 hours. Although I don't know what you friend had (it sounds like the infection started as a urinary tract infection) any person with a severe infection can die. I have seen enough examples of that. Nomen Nescio 06:37, 6 April 2006 (UTC)

Sorry to hear about your friend. The description you give sounds like it was a very tragic case. Any case, to answer the question-- septicemia can cause death and it can be quite quick, even in the young. Dying from sepsis is rarer in the young but does happen. A typical scenario would be-- a person with a bad burn--getting a bad infection and then sepsis. As for the other things-- (depression and psychosis) --they probably made the situation more difficult and possibly were the bit that tipped them over the edge. The urinary tract infection (UTI) -- is possibly where it all started... that is somewhat speculative. Nephron  T|C 20:35, 15 April 2006 (UTC)

Clear definition?

It seems to me that the article is lacking a clear definition of what sepsis "is" (as opposed to what it does, or how it is diagnosed.) As far as I know, sepsis is when the perfectly clean, antiseptic state of the inside of the body is compromised (eg. hole in the stomach leads to food actually entering the bloodstream and organ cavities). Is this correct? Either way, the page needs a better definition than the non-definition of "sepsis is a serious medical condition caused by a severe infection." I mean, I reread the article and there is literally no section describing what it is the article is talking about! I would fix this myself, but I only have the shaky definition I wrote above. 65.94.230.83 17:48, 15 April 2006 (UTC)

Quote: ...inside of the body is compromised (eg. hole in the stomach leads to food actually entering the bloodstream and organ cavities). Is this correct?

The definition is quite clear-- it is in the Definition of sepsis section. Sepsis is sort of a catch all things-- and can be caused by a lot of different things. Sometimes the cause is not known and doctors just know that things are NOT right and there is an infection. As for ...food actually entering the bloodstream... that seems rather unlikely to me. What can enter the bloodstream is a bacteria and that may come indirectly from food that is ingested and ends-up going through a hole in the stomach or the duodenum. Any time the gastrointestinal tract is perforated there is a high risk of infection (which can lead to sepsis). Nephron  T|C 20:24, 15 April 2006 (UTC)

If such is the case, I suggest mentioning in the article that sepsis is a catch-all term. Currently the definition section starts with "Sepsis can be diagnosed if" followed by a list of conditions. If there is no one definition of sepsis, perhaps this should be noted at the beginning, and the "Definition of Sepsis" section renamed to "Diagnosis of Sepsis". Unless medical conditions are always defined by their method of diagnosis? In which case, is there not some way of describing sepsis in layman terms? MrHumperdink 17:06, 29 April 2006 (UTC)

It is not "a catch-all term," since it only means that when infection (what kind can't be defined since all infections, if severe, potentially have this effect) is so severe that if the used criteria apply, we call it sepsis. Beyond that, we have septic shock. Nomen Nescio 17:34, 29 April 2006 (UTC)

Nescio is right --it isn't a catch-all. If you re-read what I wrote you'll notice I used the weasel words sort of before catch-all. Any case, I'll try and answer your questions.

Unless medical conditions are always defined by their method of diagnosis?

Medical conditions are always defined by some set of criteria and always relative to what is considered normal/healthy (based on age and sex). Most medical conditions have several criteria and are typically defined by signs and symptoms. Sometimes the criteria for a condition are exclusionary (i.e. social phobia can not be diagnosed if the patient has body dismorphic disorder).

In which case, is there not some way of describing sepsis in layman terms?

I don't think there is a good way to describe it in layman terms-- but I'll give it a try:

A person has sepsis when doctors can prove that the person has an infection with a disease causing organism (e.g. a bacterium that normally isn't found in a healthy person) and some of the person's vital signs and blood levels are abnormal.

A person with sepsis is very sick. 00:42, 30 April 2006 (UTC)

Under the "Symptoms" heading, the definition appears more to be "signs" than actual symptoms. Symptoms should be what the patient experiences or can report about his/her condition, signs would be what the doctor can conclude from tests or observation. I would like to see more discussion of what symptoms patients normally experience, such as the ones discussed on this page, like high fever, pain, difficulty breathing, etc., under the "Symptoms" heading. And then perhaps the heading should read "Signs and Symptoms," instead. My mother just died of sepsis due ultimately to multiple myeloma, and we thought she had bronchitis, the symptoms were similar. Kelelain 16:23, 25 January 2007 (UTC)Kelelain, 25 January 2007

From what I understand, Sepsis can be "defined" as an inflammatory response to an infection. The diagnosis MUST include a documented infection, and as others have already stated, a number of other criteria such as increased heart and respiratory rate. There is a paper that outlines these criteria quite well: Merx and Weber (2007). Sepsis and the Heart. Circulation 116:593-802. Grim Faerie (talk) 14:36, 18 August 2008 (UTC)

Necessary additions

This article needs a timeline or something like that, to tell how long a person with sepsis has to live. Sepsis is also very common from gunshot wounds, which is not present in the article.

There's no way to make such predictions, so there's no way to make such a timeline. People with sepsis survive diferrent lengths of time - or recover - based on many, many variables relating to their age, their state of health, the nature of the sepsis, and treatment, as well as other factors. - Nunh-huh 06:19, 17 April 2006 (UTC)

I think the question is a fair one and despite what is above I think the outcome can be predicted to some degree. APACHE II is one way of predicting outcome-- yet not specific to sepsis per se. Survival depends on many factors-- age, co-morbidity (i.e. other health problems), pregnant/non-pregnant, type of infection et cetera.

I don't think sepsis from gunshot wounds it that common. Sepsis in GSW is seen approx. in 4-5% of patients. That said, it is lethal in approx. 50% of cases. Briusov PG, Frantsuzov VN, Novozhilov AA. [Modern aspects of wound sepsis in war surgical trauma] Khirurgiia (Mosk). 1999;(10):35-8. PMID 10540551, Nechaev EA, Revskoi AK. [Gunshot wound sepsis] Khirurgiia (Mosk). 1993 Mar;(3):27-32. PMID 8089965.,

Overall death due to sepsis seems to be quite low-- vascular injuries are much more lethal. Feliciano DV, Burch JM, Spjut-Patrinely V, Mattox KL, Jordan GL Jr. Abdominal gunshot wounds. An urban trauma center's experience with 300 consecutive patients. Ann Surg. 1988 Sep;208(3):362-70. PMID 3421760. Nephron  T|C 22:11, 17 April 2006 (UTC)

If you'll read what I wrote, I think you'll find I had the APACHE variables in mind, but an APACHE score indicates relative risk, not time till death, which is what the questioner was asking for. And even if the APACHE score permitted such a calculation, the fact that there are so many variables would still make a timeline of no use. - Nunh-huh 00:21, 18 April 2006 (UTC)

You wrote: If you'll read what I wrote, I think you'll find I had the APACHE variables in mind, but an APACHE score indicates relative risk, not time till death... - survival is very much figuring-out 'til time of death i.e. die in the next week or die in twenty years from now. Doctors very often speak of time 'til death (even when it is based on estimates of a relative risk comparing survival at a point in time) doctors say to a patient with Gioblastoma multiforme you have about one year to live with best treatment (as that is the mean survival) as opposed to 3 months if one doesn't treat it.

You wrote: ... the fact that there are so many variables would still make a timeline of no use. A precise prediction cannot be made, but there is a critical period (a few days to a week) after which one can say the person will most certainly live. Hospital discharge data and length of stay... go some distance in that way. Age, severity of injury etc. can be accounted for. Lazarus HM, Fox J, Burke JP, Lloyd JF, Snow GL, Mehta RR, Evans RS, Abouzelof R, Taylor C, Stevens MH. Trauma patient hospital-associated infections: risks and outcomes. J Trauma. 2005 Jul;59(1):188-94. PMID 16096562. While variable, AFIAK, the time 'til resolution of sepsis is relatively short --when compared to something like Guillain-Barre syndrome which typically has a course of several weeks 'til resolution. Nephron  T|C 02:13, 18 April 2006 (UTC)

APACHE scores were developed to predict the likelihood of leaaving the ICU and being discharged alive, and not to predict the time frame within which that would occur or not occur. If you feel you can make a meaningful "time line for survival with sepsis", go ahead and make it. I think you'll quickly find it a waste of time. - Nunh-huh 03:57, 18 April 2006 (UTC)

APACHE scores were developed to predict the likelihood of leaaving the ICU and being discharged alive, and not to predict the time frame within which that would occur or not occur. Sure-- but the variables are probably important in time course. Any case, they are are still working on this.[1] Time of stay is a cost predictor--and it is important. Someone knows how long an average sepsis admission is... and my point is that the problems are related. I'll go back to what you said... There's no way to make such predictions, so there's no way to make such a timeline. -- I don't think that's right. The information just isn't talked about much. Any case, the following reference suggests the time course is two weeks or less[2] and possibly could be predicted by cytokine levels. Nephron  T|C 06:11, 18 April 2006 (UTC)

That's just it: talking about an "average" sepsis admission is meaningless when applied to a specific sepsis admission. When the range is wide, an average is not particularly informative. But as you feel you can produce an informative or useful timeline, we await it. - Nunh-huh 06:33, 18 April 2006 (UTC)

Septicemia

I had a baby 14 months ago and due to neglegence of the hospital I ended up with septicemia. Had 4 ops in two weeks including debridements and a historectomy. Nowhere in this talk does it say anything about what sepsis does afterwards. During my septic period i had considerable pain in my right hip and leg. As soon as the white blood cell count came down the pain would go away, when the count picked up it would be back. After the historectomy the count came down to almost normal and I was sent home. I still today have lots and lots of problems with my hip and my leg, can't sit crossed legged, can't sit stand or lie down for long periods without moving. No site that I have visited actually gives you information on what happens after this illness. Maybe you can look at doing something like this. —The preceding unsigned comment was added by 168.209.98.68 (talk • contribs) 2006-07-25t11:02:37z.

-- Jeandré, 2006-08-08t21:50z

Sounds like the past while has been very difficult, perhaps even the worst you've experienced ever. To me, it sounds like you might have had some endometritis, something that happens approximately 2% of the time after a vaginal delivery and at much higher rates after a C-section;[3] I'm guessing this by the fact that you had a baby and eventually required a hysterectomy-- but this is merely speculative.

I revised the related conditions/complications section of the article and tried to simplify the language a bit. AFAIK, the outcome of sepsis can be everything from dead to perfectly healthy after-- so what is “typical” is hard to say. Sounds like you may have had a septic hip (that is septic arthritis) as a complication. I'm not a doctor and I don't think any one can diagnose that over the internet... so take what I say with a good dose of salt. I suggest you talk with your doctor about what it is that happened to you. Any case, I hope your baby is alright. Also, I hope that you're now better since the hospitalization. Feel free to tweak the article if you feel there is something that's missing or unclear--this is the encyclopedia that any one can edit. Nephron  T|C 03:47, 9 August 2006 (UTC)

Minor edit: When the infection crosses into sepsis, the symptoms of tachycardia, tachypnea, fever and/or decreased urination.

to

When the infection crosses into sepsis, the resulting symptoms are tachycardia, tachypnea, fever and/or decreased urination. DanMcScience 20:01, 17 April 2007 (UTC)

Post: Re: clear definition; septic; septicemia:

Sepsis is a medical term that refers to combination of conditions. If a person has those conditions, then we may refer to that person as "septic".

Understanding sepsis, and how it relates to infection is important because it can sometimes develop into severe, life-threatening illness, such as septic shock or multi-organ dysfunction syndrome, which are very often deadly.

The presence of sepsis requires that 2 things must be present at the same time:

1. some sort of infection
2. the body reacting to the infection in a certain way.

The infection can originate anywhere in the body, but most often it starts in the lungs or in the urinary tract. Occasionally, it can be the result of a wound which then gets dirty, such as a gunshot wound, a surgical wound, or even a cut from broken glass, where bacteria or rarely fungus start to grow and multiply.

Normally, the immune system will contain the infection and destroy the offending bacteria right where they are. The area where the bacteria are multiplying may get hot, tender and red - this is evidence of INFLAMMATION. INFLAMMATION is tissue damage from a combination of toxins produced by the bacteria, and toxins produced by the immune system (that damage both bacteria, as well as surrounding tissue cells). If the infection is large enough, or lasts long enough, these toxins can enter the bloodstream by being absorbed into nearby veins. When this happens, it is called toxemia or septicemia (the suffix "-emia" means something "in the bloodstream").

These toxins travel through the bloodstream to distant organs and are responsible for making you feel sick, fatigued, achy, and nauseous. When they reach the brain in enough amounts, they signal the brain to raise the temperature of your body, and you will shiver uncontrollably. This is why people feel "chills" and experience what nurses and doctors call "rigors". Eventually your temperature will rise, and you will have a fever. This combination of fever, rapid heart rate, fast breathing is the body's response to a serious infection, and this is what we call SEPSIS. When this occurs, it usually means the infection is worsening.

Other changes can occur as well, some of which will only show as abnormalities on lab tests, such as increased white blood cell count, increased acid in the blood (acidemia), increased platelets, and an increase in certain proteins called "acute phase reactants". Doctors can test the blood and guess how severe an infection is by how severe someone's reaction to it is. Normally an infection will have to be quite severe or widespread before sepsis occurs.

However, everyone is different, and may react differently to the same amount of bacteria or toxin. Similarly, some bacteria produce very large amounts of or extremely toxic chemicals, that will mean sepsis occurs much earlier than in another case. As it progresses, you may experience more and more of the symptoms of sepsis, and they will become more and more severe. Hence, there are varying degrees of sepsis, from mild to severe. A person with a viral throat infection may have a rapid heart rate and a low-grade fever (less than 39 celsius) and feel fatigued. Their blood may have an increased number of white cells. Such a person could be said to be "mildly septic". This would be very different from someone with severe sepsis, who has a fever of 41, and a heart rate of 170 beats per minute, who is confused and delerious. That is to say, there are varying degrees of sepsis, from mild to severe.

To confuse matters, some people will NOT develop all of the signs or symptoms of sepsis before they progress to more severe forms. Many people, especially the very young and the elderly, for example, can even develop septic shock without ever having a fever. Some people take medications which slow the heart rate or suppress inflammation, which can mask some of the other signs and symptoms. Some people, such as organ-transplant recipients, have comprimised immune systems. It can be very difficult to diagnose sepsis in these cases. Usually however, there will be enough evidence for a doctor or other health care professional to recognize what is happening before things get out of hand.

Occasionally, the immune system will be unable to contain the bacteria before they leak into the bloodstream. This produces a very dangerous condition called bacteremia. The bacteria can lodge in distant organs such as joints, liver, kidneys, spleen, even in the heart valves. This can make it very difficult to tell where the original infection came from. It also makes the infection very difficult to treat.

This is more dangerous however, because it can activate the immune system in many places in the body all at once. However, you dont necessarily need bacteria in the blood to cause this. An infection can become so severe that large amounts of toxins are released into the blood stream. Usually by this time, however the blood will be colonized by the organism which caused the infection. widespread tissue damage, and affects the ability of the blood vessells to keep blood cells and plasma inside them. This will often result in a drop in blood pressure. When this happens, sepsis is said to be "severe sepsis". At this stage, unless the condition is diagnosed and rapidly treated, then death can be imminent. Doctors will often use intravenous fluids to raise the blood pressure of someone with severe sepsis. If this does not work, and the blood pressure stays below normal, the person is said to be in "Septic Shock".

When the blood and plasma begin to leak out of the blood vessells, they can no longer be pumped effectively to organs. Then, the organs no longer work properly and can produce even MORE toxic chemicals as they malfunction and their cells begin to die. This state is a further progression of severe sepsis and is called Multi-Organ Dysfunction, or MODS.

This response to inflammation, and progression to MODS is NOT always caused by infection: anyone with a serious allergy can attest that during a reaction, they feel as if their whole body is reacting similarly, and indeed it is. Doctors noticed over the years that regardless of the cause, there is a clear sequence of events following widespread activation of the immune system that can lead to death if not treated. Sometimes this progression halts itself, but the farther along you get, the less likely it will stop on its own. This is why doctors have carefully defined these terms and use them in a very specific way. It is vital to diagnose and treat infections before they progress to sepsis. Likewise, it is very important and recognize when someone is having a widespread immune reaction to something other than infection, a state called "Systemic Inflammatory Response Syndrome", or "SIRS".

SIRS can be caused by many things, including advanced cancer, trauma, burns, pancreatitis, severe allergic reactions (when it is called "anaphylaxis") and infection. When infection causes SIRS, we call that "sepsis". Sepsis and SIRS can lead to other things such as fluid in the lungs and the blood to spontaneously clot.

The Systemic Inflammatory Response Syndrome has a very precise definition, as does "sepsis" when it is used by doctors. Unfortunately, without understanding what SIRS is, the technical definition of sepsis is difficult to understand. Add to that the fact that most people have some idea of what is meant by sepsis, and it makes attempting a definition quite difficult. The definition of "SIRS" is at least 2 of the following 4:

1. fever defined as temperature greater than 38 celsius (or less than 36)
2. heart rate greater than 90 beats per minute
3. breathing rate greater than 20 breaths per minute
4. white blood cell (leucocyte) count greater than 12 cells/microlitre or less than 4 cells/microlitre

The techinical definition of "sepsis", as used by doctors, is: SIRS, plus evidence of infection.

(adapted from --- American College of Chest Physicians: Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit. Care Med. 20:864-875, 1992)

What exactly is evidence of infection? Certain things are obvious, such as culturing bacteria from a normally bacteria-free site (such as blood, urinary tract, knee joint), or having signs or symptoms of common infections like pneumonia, bronchitis, and cystitis (bladder infection). However as many as half of people with severe bacterial infections will not grow bacteria from blood cultures, and most doctors can diagnose many common infections without even obtaining a blood sample. Consequently, this part of the definition is not agreed upon by every doctor. The best agreed upon definitions leave some room for error, by saying "strong clinical suspicion of infection" rather than "evidence of infection". Clearly, it is better to treat too much rather than too little when the stakes are so high.

To summarize, sepsis is widespread inflammation caused by your immune system responding to a serious (but not always life-threatening) infection. Sepsis is a special case of the more general condition, "SIRS". Sepsis can be very difficult to diagnose in the young, the elderly and those taking immune-suppressing medications. Recognizing it early is important because it can be deadly if left untreated. Even without causing death it can permanently damage organs such as the liver, kidneys, and heart. It may have other long-term effects, depending on the site of the infection, but these are more likely to be caused by the infection itself. Most people with sepsis will get better once the infection clears up; but it is important to be assessed by your doctor or other health care professional to find out for sure. 142.162.71.240 20:48, 20 June 2007 (UTC) CWR B.Sc, M.D. (Canada)

Septicemia vs sepsis

Does anyone actually use the term septicemia clinically anymore? Medline Plus basically states that it is synonymous with bacteremia with sepsis, which seems more to the point and less obfuscatory, and which I think should replace all instances of septicemia in the article. And septicemia doesn't fit the pattern for similar words like bacteremia, fungemia, or viremia, which basically denote something floating around in the blood stream (something + Gk 'emia' blood). If you say septicemia, what exactly is the thing that is floating around? Aswang (talk) 20:14, 26 February 2008 (UTC)

Hi there, as an ITU nurse i can respond to this by saying that "Septicaemia" is very rarely used within the clinical setting.

Sepsis and Septic are used more widely to describe the huge spectrum of possible causes and as "Septicaemia" is actually directly related to blood poisoning it can lead to relatives percieving their loved ones to have a medical condition that they don't actually have. A person does not have to have bacteria in their blood stream in order to become septic. For example a great many septic patients become unwell from something as simple as a chest infection which does not respond to treatment at home, the infection then progresses quite aggressively and soon becomes a pneumonia. Not at anytime when blood cultures are taken is any bacteria detected in the blood stream. It must be highlighted that in most cases it is the bodies own reaction that causes a great many of the problems we face when fighting sepsis today. I fear that the piece is severely lacking a comprehensive "Physiology/pathophysiology" section and (even though i am quite new to this) i covered sepsis in some detail during my ITU course and would be happy to provide something if others to believe it would be helpful.

Septicaemia today is used (to the best of my knowledge) for the description of Bacterial Menningicoccal Spepticaemia as this is an infiltration of the blood by a highly fatal and aggressive bacteria. Septicaemia is characterised by discolouration of the skin due to the rapidly flowing toxins and with Meningicoccal infection can often lead to the loss of limbs due to the rapid cell death.

I would also like to add that it is documented that a respiratory rate of over 20 and PaCo2 of less that 4.3kpa is one symptom when in my practice it is a RR exceeding 30 that can severely compromise Co2 levels and that high Co2 levels are also indicative of sepsis. I do have many hundreds of references that may be of use but its 11 o clock at night and i have just finished a very busy late shift so you will forgive me for not having a moment to dig out the more useful ones right now, however if anyone feels i could be of use to this article then i would be happy to help (i have a huge facination with the topic).

It may also be useful to include something on the now hugely publisised Surviving Sepsis Campaign and Sepsis Care Bundles??? --Basha440 (talk) 22:16, 3 April 2008 (UTC)

Most of this has now been included. I'm happy to see that others also were amazed at the awful quality of the material in MedlinePlus and that others support the abolishment of the term septicemia. --Steven Fruitsmaak (Reply) 21:59, 12 July 2008 (UTC)

What is the difference between septicemia and blood poisoning? When I first came across this article, I interpreted the references to say that they are identical, but the current lead now says sepsis and blood poisoning have the same meaning. Is there a reference for this? --Beefyt (talk) 23:00, 12 July 2008 (UTC)

The 1991 consensus conference of the American College of Chest Physicians / Society of Critical Care Medicine concluded in reference 2 about septicemia: "this term has been used clinically and in the medical literature in a variety of ways, which has added to confusion and difficulties in data interpretation. Septicemia also does not adequately describe the entire spectrum of pathogenetic organisms that may infect the blood. We therefore suggest that this term be eliminated from current usage."

Unfortunately, if you're not familiar with these concepts, you can easily be misguided by online sources which WP:MEDRS would list as reliable. Both MedlinePlus and eMedicine make errors on this. Unless you are familiar with these concepts, I suggest you read the sources I used to back up my changes. --Steven Fruitsmaak (Reply) 23:17, 12 July 2008 (UTC)

I did read the references you added, and I agree with the suggestion that it is ill-defined, but my question is about the meaning of "blood poisoning". As far as I can tell, its a synonym for (the now antiquated) "septicemia", and not "sepsis". Is this your understanding? --68.107.9.179 (talk) 00:14, 13 July 2008 (UTC)

It's not a medical term but a layman's term, so it's not defined. I've had discussion about layman's terms before: is heart attack synonymous with myocardial infarction or acute coronary syndrome? "Septicemia" should not even be a word so it's certainly not synonymous with that. What I could imagine is that "blood poisoning" refers to a condition in which there are microbes in the blood and an ill patient: that would now be termed sepsis. I wouldn't trust eMedicine or MedlinePlus on this: after all, what is their source? --Steven Fruitsmaak (Reply) 01:44, 13 July 2008 (UTC)

If that is the case, why don't we point out in the lead that "blood poisoning" is not a precise medical term, where is "sepsis" is? Then, we may as well group it with "septicema", since they're each now undefined. Perhaps something like, "Traditionally, septicema and blood poisoning, a lay term, have described infection of the blood, but these terms have fallen out of use, as they are not well defined, in favor of more precise terms such as ..." --Beefyt (talk) 09:02, 13 July 2008 (UTC)

Blood poisoning still has a merit as a layman's term. I'll add something to the intro, feel free to copy-edit me. --Steven Fruitsmaak (Reply) 12:53, 13 July 2008 (UTC)

This whole article looks a lot better now than it did a few days ago. Thanks a lot for your expertise on the subject and for listening to my comments. I really appreciate that you were willing to discuss my misgivings as a lay person on an article with a fair amount of domain-specific detail. Also, I applaud you for discovering and correcting the original unreliable sources, something I could not have done. This article ought to be reassessed for quality now that significant edits have occurred. --Beefyt (talk) 15:08, 13 July 2008 (UTC)

I can only speak from the medical record coding side of things but we've had it drilled into us that bacteremia is simply an asymptomatic positive blood culture and sepsis requires evidence of SIRS. If the patient is symptomatic but those symptoms aren't serious enough to constitute SIRS then that is where septicemia lies and where the septicemia code alone should be used (In ICD-9 the dx of sepsis uses the combination of the codes for septicemia (038.x) plus the code for SIRS due to an infectious process (995.91)). Of course, you have to go by what the doctor actually documents rather than diagnosing things on your own - and doctors often have a terrible tendency to use the terms bacteremia and sepsis interchangeably).--209.7.195.158 (talk) 16:20, 26 May 2009 (UTC)

Bacteraemia means positive blood cultures (and frequently co-exists with sepsis: bacteraemia is seldom "asymptomatic"). Sepsis is a syndrome as defined in the article. I would, however, be cautious about condemning doctors for using the terms interchangeably, because the distinction is seldom relevant to anyone who is not a medical coder in the US  :-) --Gak (talk) 09:08, 11 June 2010 (UTC)

Causes

Doesn't seem to be anything on here on what causes these contaminants to get in the blood. 67.189.104.78 (talk) 07:24, 6 August 2008 (UTC)

That may be reflective of the complexity of sepsis. The lead covers some of the potential causes. Perhaps it can be re-factored into a new subsection which can then be expanded upon. SteveChervitzTrutane (talk) 18:21, 20 October 2008 (UTC)

The article hardly mentions who is likely to become affected by this disease. Can a healthy person become infected, or is it only people who are already ill or injured that get it? Do most of the people who get it have injuries, or does it mostly affect people who already have cancer, heart disease, pneumonia, malaria, AIDS etc? Jim Michael (talk) 02:37, 9 April 2010 (UTC)

I'd like to see causation expanded upon as well. I've just been reading on the history of Thin Lizzy and the death of lead singer Phil Lynott, who died from Sepsis as a result of his drug dependency. I have someone close who nearly died from kidney failure as a result of drug dependency (this would fall under severe sepsis if I'm reading the article correctly), and would be interested to learn more about that connection.Brakoholic (talk) 20:25, 19 December 2011 (UTC)

Prognosis

Section implies that everyone who has sepsis dies in 6 month. Clearly not true. Milik (talk)

Minor wording change: depreciated/deprecated?

Note the following sentence: "Septicemia (Also, septicaemia [sep⋅ti⋅cae⋅mi⋅a][3], or erroneously Septasemia and 'Septisema') is a related but depreciated (formerly sanctioned medical) term referring to the presence of pathogenic organisms in the bloodstream, leading to sepsis." I have practically no medical experience, but doesn't "depreciate" mean "reduce in monetary value; amortize" and "deprecate" mean "to phase out or recommend against use of"? To me, "deprecate" makes more sense in this sentence. Opinions? Thanks --Jon vs (talk) 07:05, 26 March 2009 (UTC)

Thanks to whoever changed this. Jon vs (talk) 19:36, 27 July 2009 (UTC)

Opinion in Epidemiology section

The second half of the Epidemiology section seems to contain opinion statements, but I lack the medical expertise or documentation to make the appropriate changes. Opinion statements include "the (sometimes unnecessary) use of sedation", "which runs rampants (sic) in hospitals", and "often makes the beds of intensive care patients become death beds." --72.211.209.110 (talk) 18:50, 22 April 2009 (UTC)

Blood poisoning redirect

Blood poisoning redirects here; however, lymphangitis is also called blood poisoning. JN466 18:53, 24 May 2009 (UTC)

Erroneously so. JFW | T@lk 17:03, 22 November 2011 (UTC)

Picture

What kind of picture is wanted?Doc James (talk · contribs · email) 08:47, 7 February 2010 (UTC)

Ah, could we use a picture of an adult's arm and not a freaking baby. That picture is the most depressing thing I've seen in along time and I'm in to some weird stuff, so that says allot. — Preceding unsigned comment added by 76.175.105.92 (talk) 07:45, 19 January 2013 (UTC)

I found the picture of the clearly very ill baby with its eyes covered very distressing. Please remove it or put a warning/click to view on it. I SHOULD NOT have stumbled across that picture, its very graphic and requires prior warning. - dime — Preceding unsigned comment added by 82.2.112.193 (talk) 10:43, 11 March 2014 (UTC)

WP:NOTCENSORED. You can configure your browser to block images. JFW | T@lk 14:51, 16 March 2014 (UTC)

to many white blood cells

i had a papsmear done recently. and i was told that i had a very large number of white blood cell. they said it looked like some one took a cup full of wbc and poured it onto a slide. they were unable to tell me exactly what the cause was. they did some blood test and they all came back normal. i am scared that it may be something serious. can you tell me what i can do to find out exactly what is wrong? —Preceding unsigned comment added by 98.173.180.39 (talk) 19:11, 15 April 2010 (UTC)

I really wouldn't turn to strangers for medical advice. It is also not the purpose of Wikipedia, per WP:TALK. Your question is also not pertinent to sepsis. JFW | T@lk 10:55, 4 November 2012 (UTC)

White cell counts

Someone added a request for citiation after the second set of units. I have removed the request. In my opinion, converting between cells/mm3 and cells/L is a trivial exercise and does not warrant a citation request. The relevant section of text is below:

White blood cell count < 4,000 cells/mm3 or > 12,000 cells/mm3 (< 4 × 109 or > 12 × 109 cells/L), or greater than 10% band forms (immature white blood cells). (leukopenia, leukocytosis, or bandemia).

--Gak (talk) 08:54, 11 June 2010 (UTC)

Contradiction Tag

What's the deal with this? I am going to remove it. If anyone disagrees please reinstate it and explain.--Adam in MO Talk 21:09, 18 November 2010 (UTC)

Why no mention of procalcitonin

Is procalcitonin (PCT) testing not widely enough used in USA or elsewhere for sepsis rule-in or rule-out to be mentioned in this article ? - Rod57 (talk) 15:43, 5 May 2011 (UTC)

Seems a reasonable question. Do you have any particularly strong WP:MEDRS-compliant sources that we could use for this? JFW | T@lk 13:33, 22 May 2012 (UTC)

doi:10.1128/CMR.00016-12 may be a useful source for this. JFW | T@lk 10:52, 4 November 2012 (UTC)

References

• Soong, J (2012 Jun). "Sepsis: recognition and treatment". Clinical medicine (London, England). 12 (3): 276–80. PMID 22783783. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Martin, GS (2012 Jun). "Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes". Expert review of anti-infective therapy. 10 (6): 701–6. PMID 22734959. {{cite journal}}: Check date values in: |date= (help)
• Riedel, S (2012 Jul). "Procalcitonin and the role of biomarkers in the diagnosis and management of sepsis". Diagnostic microbiology and infectious disease. 73 (3): 221–7. PMID 22704255. {{cite journal}}: Check date values in: |date= (help)
• Ward, PA (2012 Jul). "A historical perspective on sepsis". The American journal of pathology. 181 (1): 2–7. PMID 22642906. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)</ref>
• Mapatuna, CR (2012 Jun). "Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: Which fluid (colloids or crystalloids) is better in initial resuscitation of severe sepsis?". Emergency medicine journal : EMJ. 29 (6): 509–11. PMID 22635390. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:31, 4 November 2012 (UTC)

More References:

• Annane D, Bellissant E, Cavaillon JM (2005). "Septic shock". Lancet. 365 (9453): 63–78. doi:10.1016/S0140-6736(04)17667-8. PMID 15639681.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Dellinger RP, Levy MM, Carlet JM; et al. (2008). "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008". Crit. Care Med. 36 (1): 296–327. doi:10.1097/01.CCM.0000298158.12101.41. PMID 18158437. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Martin GS, Mannino DM, Moss M (2006). "The effect of age on the development and outcome of adult sepsis". Crit. Care Med. 34 (1): 15–21. PMID 16374151. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Esper AM, Martin GS (2009). "Extending international sepsis epidemiology: the impact of organ dysfunction". Crit Care. 13 (1): 120. doi:10.1186/cc7704. PMC 2688124. PMID 19291262.{{cite journal}}: CS1 maint: unflagged free DOI (link)
• Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ (2011). "Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis". JAMA. 306 (20): 2248–54. doi:10.1001/jama.2011.1615. PMC 3408087. PMID 22081378. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Danai PA, Moss M, Mannino DM, Martin GS (2006). "The epidemiology of sepsis in patients with malignancy". Chest. 129 (6): 1432–40. doi:10.1378/chest.129.6.1432. PMID 16778259. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Labelle A, Juang P, Reichley R; et al. (2012). "The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment*". Crit. Care Med. 40 (7): 2016–21. doi:10.1097/CCM.0b013e318250aa72. PMID 22584765. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

Mike Turken (talk · contribs · email) (If I write on your page, please reply on mine.) 02:02, 21 December 2012 (UTC)

For this article, I think we need to start by slashing the stuff that either of marginal relevance or based entirely on primary sources. I have just chopped from "signs and symptoms" a whole raft of badly written stuff that was about pathophysiology and not about signs or symptoms. The current "pathophysiology" section is awful and doesn't begin to describe the current knowledge base about PAMP/DAMP responses and "compensatory anti-inflammatory response syndrome" (CARS). I quite enjoyed doi:10.1128/CMR.00016-12 for summarising some recent insights. JFW | T@lk 11:25, 4 November 2012 (UTC)

Great to have you join in. Am planning on working on bringing this to GA next. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:34, 4 November 2012 (UTC)

My contribution will be patchy, owing to meatspace time commitments, but I have recently been doing some reading and teaching on this. It would be great to have someone with a critical care interest on board. JFW | T@lk 11:48, 4 November 2012 (UTC)

Picture

What should we use in the lead? A picture of the meningitis rash. A picture of bacteria. A picture of the classification system [4] Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:48, 5 November 2012 (UTC)

The current picture is not ideal, because it is a bit alarmist (most people with sepsis don't get limb gangrene). I would have no problem with a picture of blood culture bottles, some Gram negative rods under a microscope... JFW | T@lk 20:41, 5 November 2012 (UTC)

Blood culture bottles are a good idea. I will get some pictures in a few weeks. Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:34, 5 November 2012 (UTC)

Again, I highly suggest you change the picture of the baby's arms. It very disturbing and I'm sure there's a more appropriate picture out there. — Preceding unsigned comment added by 76.175.105.92 (talk) 07:49, 19 January 2013 (UTC)

New review for 2013

Dellinger, RP (2013 Feb). "Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2012". Critical care medicine. 41 (2): 580–637. PMID 23353941. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:30, 23 February 2013 (UTC)

Awesome! Thanks for posting this. And thanks for changing the photo, too. Mike Turken (talk · contribs · email) (If I write on your page, please reply on mine.) 21:00, 1 March 2013 (UTC)

How does sepsis kill?

doi:10.1164/rccm.201211-1983OC - not (yet) for inclusion, but postmortem results show that those dying from sepsis have cardiomyocyte injury and focal renal tubular abnormalities. JFW | T@lk 13:54, 1 March 2013 (UTC)

reverted this

[5]

• primary source see WP:MEDRS
• date 1981 see WP:MEDDATE
• searching the reference gives the term sepsis twice, but both as "intra-abdominal sepsis", which is not really what this article discusses (see comments above about "sepsis" sometimes being a synonym for "infection" generally rather than specifically septicemia).
• also not convinced that surgical mesh would be a common cause for septicemia, and this content was added to the 2nd para of lead where the condition was being discussed very generally. Lesion (talk) 01:46, 16 March 2013 (UTC)

Statins

Observational studies have alluded to a benefit from statins, but most of the research is too weak to draw strong conclusions (says meta-analysis). doi:10.1186/cc13828 JFW | T@lk 19:58, 28 April 2014 (UTC)

Table including new Diagnostic Criteria

Trying to incorporate new Surviving Sepsis Campaign diagnostic criteria into a table. Any thoughts about size/usability? Will edit text so that it's not so directly taken from the guidelines. But I also wondered if it might be more valuable to organize by kind of finding (physical exam vs. lab, or break it down by vitals). Thoughts?

2013 "Surviving Sepsis Campaign" Diagnostic Criteria for Sepsis: Infection, documented or suspected, and some of the following:

General	Inflammatory markers	Hemodynamics and perfusion	Organ dysfunction
Fever >38.3C	Leukocytosis (WBC count >12,000/uL)	Arterial Hypotension ( SBP <90mm HG, MAP <70mmHg, or an SBP decrease >40mm Hg in adults or less than 2 SD below normal for age)	Arterial hypoxemia (PaO2/FIO2<300)
Hypothermia < 36C	Low white blood cell (count <4,000/uL)	High lactate level (> 1 mmol/L)	Acute oliguria (urine output < 0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation)
Heart Rate >90/min or more than 2SD above normal value for age >38.3C	Normal WBC count with greater than 10% immature forms	Decreased capillary refill or mottling	Creatinine increase > 0.5mg/dL or 44.2 μmol/L
Tachypnea	Plasma C-reactive protein more than 2SD above normal		Coagulation abnormalities (INR > 1.5 or aPTT > 60 s)
Altered mental status	Plasma procalcitonin more than 2SD above normal		Absent bowel sounds
Significant edema or positive fluid balance (>20mL/kg over 24hr)			Low platelets (platelet count < 100,000/μL)
High blood sugar (plasma glucose>140mg/dL in the absence of diabetes)			Hyperbilirubinemia (plasma total bilirubin > 4mg/dL or 70 μmol/L)

Mike Turken (talk · contribs · email) (If I write on your page, please reply on mine.) 18:29, 30 April 2013 (UTC)

Nice work. Some questions: (a) are all units in SI? (b) is "C" a unit of temperature, or should you include a degrees symbol? (c) how are SD defined/used in a clinical context? (d) is this encyclopedic? It borders on how-to, absent text that develops concepts related to sepsis with reference to these criteria. -- Scray (talk) 04:58, 1 May 2013 (UTC)

IMO the presentation could use a bit of work. Half the table is empty. Is there some way we can make it more compact. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:22, 1 May 2013 (UTC)

I agree the format is not ideal, but nor is the list format in the published paper. It would be easy to condense this into 4 columns of roughly equal size by re-organizing as Vital Sign Abnormalities, Physical Exam Findings, Labs, but would this be too much of a change to still cite the article? This diagnostic rubric is so vague as to be not terribly useful, but I think the article should have all of these listed somewhere. 199.188.195.183 (talk) 20:56, 1 May 2013 (UTC)

We listed low temp 3 times... Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:24, 2 May 2013 (UTC)

Some of this is also overlap with the SIRS table. Doc James (talk · contribs · email) (if I write on your page reply on mine) 09:59, 2 May 2013 (UTC)

I agree, and I like the simplicity of the SIRS table. I just think the list below of manifestations for different organ systems is hard to read. I'm gonna go for a simplified table that expands on the SIRS table a bit, but we can certainly keep the SIRS table, too.Mike Turken (talk · contribs · email) (If I write on your page, please reply on mine.) 23:04, 2 May 2013 (UTC)

References

Blog

Why do we need the NEJM blog [6] as a ref? When the full article is freely accessible here [7]? Blogs are not typically deemed reliable sources. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:26, 7 September 2013 (UTC)

I wouldn't say we need it. But I wouldn't think it would be unreliable either. So I don't see any potential harm, unless we have reason to believe the NEJM would allow an unreliable summary to be published. Biosthmors (talk) 20:32, 7 September 2013 (UTC)

We simply do not need more than one reliable ref for a non controversial point. Doc James (talk · contribs · email) (if I write on your page reply on mine) 20:39, 7 September 2013 (UTC)

That's certainly true. But readers may find the link helpful. Biosthmors (talk) 20:46, 7 September 2013 (UTC)

That is not a reason to add a reference. We are not a collection of external links. We do not add 10 references to each sentence just because readers may find them useful. WP:V is about verifying content. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:28, 8 September 2013 (UTC)

That's certainly true. But the one {{cite journal}} parameter for a laysource is hardly a collection of links. Biosthmors (talk) 09:18, 8 September 2013 (UTC)

Yes do not mind it combined as a laysource. It was the efforts to slit it out as its own that I disagreed with. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:10, 8 September 2013 (UTC)

I think consensus is behind this last edit of mine then. Now on to other things! Biosthmors (talk) 17:20, 8 September 2013 (UTC)

I set it with the layurl parameter. - - MrBill3 (talk) 08:08, 26 November 2014 (UTC)

References formatted

I have uniformly formatted the references. For journals I have used last name, first initial with displayauthors set to 4. I used the full journal name and wl'd when possible. I have added urls to content available online. While the doi is more stable, a doi provides no clue if a subscription is required for a particular article. Where the url is not from the publisher I have added the via parameter to help resolve any copyright issues. To the extent possible I have completed the references, full author listing, pmid, doi etc.

If the authorship is attributed to a group(s), I used the group(s) as the first author. This isn't standard in scholarly citations but I think it is appropriate on WP. I made one exception where there were a multitude of groups all named in the title of the article.

I have also set up auto archiving for this talk page, 90 days, archive by number, indexed using ClueBot III.

I added a few update needed tags, one for a Cochrane review that has a more recent version and one for the Surviving Sepsis 2008 guidelines for which we should be using the 2012 guidelines (already a named ref in the article). Best. - - MrBill3 (talk) 08:04, 26 November 2014 (UTC)

Mobilisation

... after severe sepsis is logical but has been extremely poorly studied. doi:10.1002/jhm.2281. Probably can't be included as the review concedes that the research still needs to be done. JFW | T@lk 17:48, 19 November 2014 (UTC)

Ref

Angus, DC; van der Poll, T (August 29, 2013). "Severe sepsis and septic shock". The New England Journal of Medicine. 369 (9): 840–51. doi:10.1056/NEJMra1208623. PMID 23984731. {{cite journal}}: Unknown parameter |laydate= ignored (help); Unknown parameter |layurl= ignored (help) Doc James (talk · contribs · email) 10:22, 28 November 2014 (UTC)

Sepsis can be thought of as falling within a continuum from infection to multiple organ dysfunction syndrome. Moved here as not really true. Doc James (talk · contribs · email) 10:58, 28 November 2014 (UTC)

It is a valid point. We had a presentation from Ron Daniels (Sepsis UK) yesterday and it is not easy to risk profile people with "sepsis" (fever, tachycardia in the context of a viral infection) and "sepsis" (fever, tachycardia in the context of lobar pneumonia who will have multiple organ dysfunction within hours). In that sense, the concept is very inclusive and this article is mostly about severe sepsis. JFW | T@lk 12:28, 28 November 2014 (UTC)

Might fit better in the body of the text. Doc James (talk · contribs · email) 13:22, 28 November 2014 (UTC)

References

Cause

The section "Cause" could probably be improved. I have updated the reference, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases to the 8th ed. with a link to the chapter. The Google Books preview from my location allows the chapter to be read. I think the section does not represent what the source says precisely (this edition seems updated). It's great to see this important article getting some work.

As a side note, I can provide a single copy of the updated Cochrane article to an editor for improving this article via email. - - MrBill3 (talk) 06:15, 29 November 2014 (UTC)

Yes does need work. I will come back to it eventually. Would be great if others could jump in. Doc James (talk · contribs · email) 11:53, 29 November 2014 (UTC)

Can we be a bit more specific as to what this section needs? What are we going to put in this section that is not covered in pathophysiology so we don't become redundant? TylerDurden8823 (talk) 22:19, 4 December 2014 (UTC)

Treatment

This "In 2006, following the Surviving Sepsis Campaign a set of medical therapies aimed at reducing the mortality rates from severe sepsis was developed by those workers involved in the campaign. These were named the Sepsis Six and consists of three diagnostic and three therapeutic steps – all to be delivered within one hour of the initial diagnosis of sepsis.

Deliver high-flow oxygen. Take blood cultures. Administer empiric intravenous antibiotics. Measure serum lactate and send full blood count. Start intravenous fluid resuscitation. Commence accurate urine output measurement.

The adoption of the Sepsis Six in centres in many countries has been associated with decreased mortality, decreased length of hospitalisation and days spent in intensive care units."

Is not supported by a good enough ref. Does not belong in the treatment section as half of it is diagnosis. And is already covered. Doc James (talk · contribs · email) 15:27, 4 December 2014 (UTC)

Interesting dilemma. In the UK the "Sepsis Six" have rapidly gained hold in the curriculum and just the other day I affirmed that people who have recently completed medical school have learnt to use this strategy in people with sepsis. I agree that Daniels et al shouldn't be included, but neither can I find a great secondary source (apart perhaps from PMID 23364109, which is Daniels in a small journal). Many professional readers would be surprised to find this not mentioned, but perhaps I'm being too UK-centric. JFW | T@lk 22:45, 4 December 2014 (UTC)

Never heard of it. Not as notable as EGDT. Does NICE comment on this? Doc James (talk · contribs · email) 00:10, 5 December 2014 (UTC)

I have now included it as part of the bundle-driven initial management of sepsis. PMID 21398303 is a secondary source from JACC, which is a core infection journal. Including SIGN as well. JFW | T@lk 20:57, 6 December 2014 (UTC)

References

SIRS is not sepsis

Sepsis is SIRS plus infection. I think we need to keep the lead simple. Thus removed "SIRS can also be caused by other non-infectious conditions such as pancreatitis, reperfusion injury, or cancer." as this is in the body already. Doc James (talk · contribs · email) 14:17, 6 December 2014 (UTC)

I agree that for now, we keep the lead simple, but just so it's clear why I made that change, the reason I put it that way in an earlier edit was because the cited review (from the highly respected journal Immunity) explicitly stated that sepsis (not SIRS) can be caused by non-infectious conditions such as those listed above. However, I'm going to see if this is now a commonly employed definition in mainstream reviews. If not, perhaps it hasn't really gained traction in the mainstream yet, but I will take a look. Doc and I have discussed possibly moving an explanation of such differing definitions to the diagnosis section where definitions for sepsis are already discussed. I do still think we should say it is a syndrome of whole body inflammation in the lead though, that was also made clear by that review. Do you agree James? TylerDurden8823 (talk) 15:47, 6 December 2014 (UTC)

I think it is important to keep the introduction simple. Not sure saying that it is a syndrome is needed in the lead.

This is the most widely accepted position from the 2012 surviving sepsis campaign "sepsis is a systemic, deleterious host response to infection" [8] which we have summarized as "sepsis is whole-body inflammation caused by an infection" The NIH uses something similar [9]

I would say this definition is not a widely accepted yet "sepsis, a clinical syndrome occurring in patients following infection or injury" [10] User:Jfdwolff your thoughts?Doc James (talk · contribs · email) 04:20, 7 December 2014 (UTC)

Why not (about the syndrome part I mean)? I don't think this necessarily makes the lead seem complex, but I'm not married to having the bit about sepsis being a syndrome in the lead section. It can go elsewhere, but I think it belongs somewhere in the article. I agree that SCCM is likely the most widely accepted definition, but the source mentioned is newer so it may be a newer line of thought, but as I said I'll have to go through the literature and see if it has gained widespread acceptance in the literature or if it is still considered a pretty novel take on the definition. I would also like to hear other opinions as well. JFW? TylerDurden8823 (talk) 04:39, 7 December 2014 (UTC)

I do not see calling it a syndrome to be very important to the general population. Agree that it can go in the body. To write in basic English using short sentences and simple words is important. Doc James (talk · contribs · email) 19:01, 7 December 2014 (UTC)

I have no objection to that and agree the lead should be simple. I don't think saying it's a syndrome makes it very complicated, but you may have a point that the general audience may not care that much that it's a syndrome and it can just be in the article's body. TylerDurden8823 (talk) 19:20, 7 December 2014 (UTC)

Thanks, the difference between a syndrome, disease, association and condition is rather complicated. And often used incorrectly. Doc James (talk · contribs · email) 19:29, 7 December 2014 (UTC)

I think it is important to mention/discuss non infectious causes in the body. Identifying it as only due to infection in lead seems inconsistent with that. I haven't had a chance to review and check what the most recent literature concludes. Has non infectious systemic inflammatory response been made distinct from sepsis? - - MrBill3 (talk) 04:37, 8 December 2014 (UTC)

There are lots of refs that just say infectious such as [11]. The other definition may be a misunderstanding / type. "sepsis, a clinical syndrome occurring in patients following infection or injury" [12]

If there is no infection than it is "non-infectious SIRS" per [13] Doc James (talk · contribs · email) 04:48, 8 December 2014 (UTC)

Normally, I completely agree, I've never seen the term sepsis used in real life to refer to anything non-infectious and it has always been non-infectious SIRS as you say. All I can say is that the Immunity review specifically said sepsis. If that was a typo or an error, then this is a rather significant oversight by the Immunity's editing staff. I felt it might be worth including since this seems to be a highly reputable journal with a strong impact factor and an updated review. I haven't looked through the literature to see if this definition is used elsewhere, but earlier as I went through reviews I recall seeing many define sepsis as infectious SIRS. So, I guess time will tell if this becomes mainstream or if it was just an error by the journal. TylerDurden8823 (talk) 04:56, 8 December 2014 (UTC)

Most of what I am seeing is using "non infectious SIRS" for non infectious causes. The Immunity article carries weight so I leave this to a consensus of experienced editors. - - MrBill3 (talk) 05:18, 8 December 2014 (UTC)

I think it's okay to not use the definition from Immunity for the moment and see if additional new reviews employ a similar definition including infectious and non-infectious etiologies or if new reviews continue to define sepsis as exclusively SIRS from an infectious etiology. Do others agree that this is a reasonable course of action? I do think the immunity article carries weight as Bill said, but not so much that it would outweigh the remainder of the literature if it is discordant with it. TylerDurden8823 (talk) 05:44, 8 December 2014 (UTC)

Update on this-I found a new review in Mayo Clinic Proceedings and this review seems to agree with the infectious side rather than the broader definition of including non-infectious etiologies. Pending additional review articles from high-quality sources or authoritative guidelines explicitly stating that the definition has changed, I think it's prudent to keep it as is. TylerDurden8823 (talk) 04:49, 14 December 2014 (UTC)