Sepsis surveillance using adult sepsis events simplified eSOFA criteria versus sepsis-3 sequential organ failure assessment criteria.
Open accessAbstract
Objectives: Sepsis-3 defines organ dysfunction as an increase in the Sequential Organ Failure Assessment score by greater than or equal to 2 points. However, some Sequential Organ Failure Assessment score components are not routinely recorded in all hospitals’ electronic health record systems, limiting its utility for wide-scale sepsis surveillance. The Centers for Disease Control and Prevention recently released the Adult Sepsis Event surveillance definition that includes simplified organ dysfunction criteria optimized for electronic health records (eSOFA). We compared eSOFA versus Sequential Organ Failure Assessment with regard to sepsis prevalence, overlap, and outcomes. Design: Retrospective cohort study. Setting: One hundred eleven U.S. hospitals in the Cerner HealthFacts dataset. Patients: Adults hospitalized in 2013-2015. Interventions: None. Measurements and Main Results: We identified clinical indicators of presumed infection (blood cultures and antibiotics) concurrent with either: 1) an increase in Sequential Organ Failure Assessment score by 2 or more points (Sepsis-3) or 2) 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, lactate greater than or equal to 2.0 mmol/L, doubling in creatinine, doubling in bilirubin to greater than or equal to 2.0 mg/dL, or greater than or equal to 50% decrease in platelet count to less than 100 cells/μL (Centers for Disease Control and Prevention Adult Sepsis Event). We compared area under the receiver operating characteristic curves for discriminating in-hospital mortality, adjusting for baseline characteristics. Of 942,360 patients in the cohort, 57,242 (6.1%) had sepsis by Sequential Organ Failure Assessment versus 41,618 (4.4%) by eSOFA. Agreement between sepsis by Sequential Organ Failure Assessment and eSOFA was good (Cronbach’s alpha 0.81). Baseline characteristics and infectious diagnoses were similar, but mortality was higher with eSOFA (17.1%) versus Sequential Organ Failure Assessment (14.4%; p < 0.001) as was discrimination for mortality (area under the receiver operating characteristic curve, 0.774 vs 0.759; p < 0.001). Comparisons were consistent across subgroups of age, infectious diagnoses, and comorbidities. Conclusions: The Adult Sepsis Event’s eSOFA organ dysfunction criteria identify a smaller, more severely ill sepsis cohort compared with the Sequential Organ Failure Assessment score, but with good overlap and similar clinical characteristics. Adult Sepsis Events may facilitate wide-scale automated sepsis surveillance that tracks closely with the more complex Sepsis-3 criteria.
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Cites
The third international consensus definitions for sepsis and septic shock (Sepsis-3).
Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., Bellomo, R., Bernard, G. R., Chiche, J.-D., Coopersmith, C. M., et al. (2016) · JAMA · doi:10.1001/jama.2016.0287 · Cited by 28,250 · see citing works
Self-citationVincent, J. L., Moreno, R., Takala, J., Willatts, S., De Mendonça, A., Bruining, H., Reinhart, C. K., Suter, P. M., & Thijs, L. G. (1996) · Intensive Care Medicine · doi:10.1007/bf01709751 · Cited by 11,674 · see citing works
Seymour, C. W., Liu, V. X., Iwashyna, T. J., Brunkhorst, F. M., Rea, T. D., Scherag, A., Rubenfeld, G., Kahn, J. M., Shankar-Hari, M., Singer, M., et al. (2016) · JAMA · doi:10.1001/jama.2016.0288 · Cited by 3,939 · see citing works
Self-citationSurviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002255 · Cited by 3,652 · see citing works
Self-citationThe reliability of a two-item scale: Pearson, Cronbach, or spearman-brown?
Eisinga, R., Grotenhuis, M. T., & Pelzer, B. (2013) · International Journal of Public Health · doi:10.1007/s00038-012-0416-3 · Cited by 2,695 · see citing works
van Walraven, C., Austin, P. C., Jennings, A., Quan, H., & Forster, A. J. (2009) · Medical Care · doi:10.1097/mlr.0b013e31819432e5 · Cited by 2,200 · see citing works
Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014.
Rhee, C., Dantes, R., Epstein, L., Murphy, D. J., Seymour, C. W., Iwashyna, T. J., Kadri, S. S., Angus, D. C., Danner, R. L., Fiore, A. E., et al. (2017) · JAMA · doi:10.1001/jama.2017.13836 · Cited by 1,884 · see citing works
Self-citationRaith, E. P., Udy, A. A., Bailey, M., McGloughlin, S., MacIsaac, C., Bellomo, R., Pilcher, D. V., & for the Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE) (2017) · JAMA · doi:10.1001/jama.2016.20328 · Cited by 1,279 · see citing works
Jones, A. E., Trzeciak, S., & Kline, J. A. (2009) · Critical Care Medicine · doi:10.1097/ccm.0b013e31819def97 · Cited by 853 · see citing works
The Logistic Organ Dysfunction System
Gall, J. L. (1996) · JAMA · doi:10.1001/jama.1996.03540100046027 · Cited by 733 · see citing works
Churpek, M. M., Snyder, A., Han, X., Sokol, S., Pettit, N., Howell, M. D., & Edelson, D. P. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201604-0854oc · Cited by 689 · see citing works
Gall, J. L. (1996) · JAMA · doi:10.1001/jama.276.10.802 · Cited by 545 · see citing works
Serum Potassium Levels and Mortality in Acute Myocardial Infarction
Goyal, A., Spertus, J. A., GOSCH, K. L., Venkitachalam, L., Jones, P. G., den Berghe, G. V., & Kosiborod, M. (2012) · JAMA · doi:10.1001/jama.2011.1967 · Cited by 376 · see citing works
Interrater reliability of Glasgow Coma Scale scores in the emergency department
Gill, M. R., Reiley, D. G., & Green, S. M. (2004) · Annals of Emergency Medicine · doi:10.1016/s0196-0644(03)00814-x · Cited by 279 · see citing works
Kadri, S. S., Rhee, C., Strich, J. R., Morales, M. K., Hohmann, S. F., Menchaca, J., Suffredini, A. F., Danner, R. L., & Klompas, M. (2016) · CHEST Journal · doi:10.1016/j.chest.2016.07.010 · Cited by 243 · see citing works
Self-citationRegulatory Mandates for Sepsis Care — Reasons for Caution
Rhee, C., Gohil, S. K., & Klompas, M. (2014) · New England Journal of Medicine · doi:10.1056/nejmp1400276 · Cited by 232 · see citing works
Self-citationInfectious Disease Hospitalizations in the United States
Christensen, K. L. Y., Holman, R. C., Steiner, C., Sejvar, J. J., Stoll, B. J., & Schonberger, L. B. (2009) · Clinical Infectious Diseases · doi:10.1086/605562 · Cited by 220 · see citing works
Simpson, S. Q. (2016) · CHEST Journal · doi:10.1016/j.chest.2016.02.653 · Cited by 215 · see citing works
Diagnosing sepsis is subjective and highly variable: A survey of intensivists using case vignettes.
Rhee, C., Kadri, S. S., Danner, R. L., Suffredini, A. F., Massaro, A. F., Kitch, B. T., Lee, G., & Klompas, M. (2016) · Critical Care · doi:10.1186/s13054-016-1266-9 · Cited by 187 · see citing works
Self-citationA Comparative Analysis of Sepsis Identification Methods in an Electronic Database*
Johnson, A. E. W., Aboab, J., Raffa, J. D., Pollard, T., Deliberato, R. O., Celi, L. A., & Stone, D. J. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000002965 · Cited by 186 · see citing works
Angus, D. C., Seymour, C. W., Coopersmith, C. M., Deutschman, C. S., Klompas, M., Levy, M. M., Martin, G. S., Osborn, T. M., Rhee, C., & Watson, R. S. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001730 · Cited by 164 · see citing works
Self-citationGlasgow Coma Scale Scoring is Often Inaccurate
Bledsoe, B. E., Casey, M. J., Feldman, J., et al. (2014) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x14001289 · Cited by 109 · see citing works
Macdonald, S. P. J., Arendts, G., Fatovich, D. M., & Brown, S. G. A. (2014) · Academic Emergency Medicine · doi:10.1111/acem.12515 · Cited by 97 · see citing works
Lagu, T. C., Pekow, P. S., Shieh, M., Stefan, M. S., Pack, Q. R., Kashef, M. A., Atreya, A. R., Valania, G. E., Slawsky, M., & Lindenauer, P. K. (2016) · Circulation Heart Failure · doi:10.1161/circheartfailure.115.002912 · Cited by 95 · see citing works
Objective Sepsis Surveillance Using Electronic Clinical Data
Rhee, C., Kadri, S. S., Huang, S. S., Murphy, M. V., Li, L., Platt, R. G., & Klompas, M. (2015) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2015.264 · Cited by 86 · see citing works
Self-citationChurpek, M. M., Snyder, A. M., Sokol, S. S., Pettit, N. N., & Edelson, D. P. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002648 · Cited by 73 · see citing works
Application of a framework to assess the usefulness of alternative sepsis criteria
Seymour, C. W., Coopersmith, C. M., Deutschman, C. S., Gesten, F., Klompas, M., Levy, M., Martin, G. S., Osborn, T. M., Rhee, C., Warren, D. K., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001724 · Cited by 71 · see citing works
Self-citationChoudhry, S. A., Li, J., Davis, D. A., Erdmann, C., Sikka, R., & Sutariya, B. B. (2013) · Online Journal of Public Health Informatics · doi:10.5210/ojphi.v5i2.4726 · Cited by 68 · see citing works
Rothberg, M. B., Pekow, P. S., Priya, A., & Lindenauer, P. K. (2014) · Annals of Internal Medicine · doi:10.7326/m13-1419 · Cited by 60 · see citing works
Rhee, C., Murphy, M. V., Li, L., Platt, R. G., & Klompas, M. (2015) · Critical Care · doi:10.1186/s13054-015-1048-9 · Cited by 59 · see citing works
Self-citationDrug-Drug Interaction Associated with Mold-Active Triazoles among Hospitalized Patients
Andes, D. R., Azie, N. E., Yang, H., Harrington, R. L., Kelley, C., Tan, R., Wu, E. Q., Franks, B., Kristy, R. M., Lee, E. W., et al. (2016) · Antimicrobial Agents and Chemotherapy · doi:10.1128/aac.00054-16 · Cited by 56 · see citing works
Stevenson, J. E., Israelsson, J., Nilsson, G. C., Petersson, G., & Bath, P. A. (2014) · Health Informatics Journal · doi:10.1177/1460458214530136 · Cited by 53 · see citing works
Prevalence and Prognosis of Hyperkalemia in Patients with Acute Myocardial Infarction
Grodzinsky, A., Goyal, A., GOSCH, K. L., et al. (2016) · The American Journal of Medicine · doi:10.1016/j.amjmed.2016.03.008 · Cited by 45 · see citing works
Temporal trends of esophageal disorders by age in the Cerner Health Facts database
Petrick, J. L., Nguyen, T. A. T., & Cook, M. B. (2015) · Annals of Epidemiology · doi:10.1016/j.annepidem.2015.11.004 · Cited by 32 · see citing works
Factors influencing the quality of vital sign data in electronic health records: A qualitative study
Stevenson, J. E., Israelsson, J., Petersson, G., & Bath, P. A. (2017) · Journal of Clinical Nursing · doi:10.1111/jocn.14174 · Cited by 29 · see citing works
Definitions for Sepsis and Septic Shock
Townsend, S. R., Rivers, E. P., & Tefera, L. (2016) · JAMA · doi:10.1001/jama.2016.6374 · Cited by 21 · see citing works
Chan, W. W., Johnson, K. W., Friedman, H. S., et al. (2016) · Hospital Practice · doi:10.1080/21548331.2016.1197760 · Cited by 10 · see citing works
We Need Better Tools for Sepsis Surveillance*
Klompas, M., & Rhee, C. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001766 · Cited by 7 · see citing works
Self-citation
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Sorted by citations
Wynn, J. L., & Polin, R. A. (2020) · Pediatric Research · doi:10.1038/s41390-019-0517-2 · Cited by 169 · see citing works
Henry, K. E., Adams, R., Parent, C., Soleimani, H., Sridharan, A., Johnson, L., Hager, D. N., Cosgrove, S. E., Markowski, A., Klein, E. Y., et al. (2022) · Nature Medicine · doi:10.1038/s41591-022-01895-z · Cited by 127 · see citing works
Rhee, C., Wang, R., Zhang, Z., Fram, D., Kadri, S. S., & Klompas, M. (2019) · Critical Care Medicine · doi:10.1097/ccm.0000000000003817 · Cited by 122 · see citing works
Self-citationRhee, C., Yu, T., Wang, R., Kadri, S. S., Fram, D., Chen, H.-C., Klompas, M., & Program, C. P. E. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.38596 · Cited by 81 · see citing works
Self-citationSepsis prediction model for determining sepsis vs SIRS, qSOFA, and SOFA
Schertz, A. R., Lenoir, K. M., Bertoni, A. G., Levine, B. J., Mongraw-Chaffin, M., & Thomas, K. W. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.29729 · Cited by 78 · see citing works
Evaluation of sepsis prediction models before onset of treatment
Kamran, F., Tjandra, D., Heiler, A., Virzi, J., Singh, K., King, J. E., Valley, T. S., & Wiens, J. (2024) · NEJM AI · doi:10.1056/aioa2300032 · Cited by 74 · see citing works
Association between Adherence to Recommended Care and Outcomes for Adult Survivors of Sepsis
Taylor, S. P., Chou, S.-H., Sierra, M. F., Shuman, T. P., McWilliams, A. D., Taylor, B. T., Russo, M., Evans, S. L., Rossman, W., Murphy, S., et al. (2020) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201907-514oc · Cited by 69 · see citing works
Trends in empiric broad-Spectrum antibiotic use for suspected community-onset Sepsis in US hospitals
Rhee, C., Chen, T., Kadri, S. S., Lawandi, A., Yek, C., Walker, M., Warner, S., Fram, D., Chen, H.-C., Shappell, C. N., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.18923 · Cited by 58 · see citing works
Self-citationRhee, C., Strich, J. R., Chiotos, K., Classen, D. C., Cosgrove, S. E., Greeno, R., Heil, E. L., Kadri, S. S., Kalil, A. C., Gilbert, D. N., et al. (2024) · Clinical Infectious Diseases · doi:10.1093/cid/ciad447 · Cited by 40 · see citing works
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- Authors
- Rhee, C., Zhang, Z., Kadri, S. S., Murphy, D. J., Martin, G. S., Overton, E., Seymour, C. W., Angus, D. C., Dantes, R., Epstein, L., Fram, D., Schaaf, R., Wang, R., & Klompas, M.
- Affiliations
- Brigham and Women's Hospital (US)
- Harvard University (US)
- National Institutes of Health (US)
- Emory University (US)
- University of Pittsburgh (US)
- Centers for Disease Control and Prevention (US)
- Commonwealth Informatics, Waltham, MA.
- ORCID
- Venue
- Critical Care Medicine
- Published
- 2019-03
- Volume
- 47
- Issue
- 3
- Pages
- 307-314
- ISSN
- 0090-3493 (ISSN-L)
- PMC
- PMC6383796
- OpenAlex
- W2918426727
- Cited by
- 128
- References
- 38
- Citations by year
- 2026: 8 · 2025: 21 · 2024: 15 · 2023: 20 · 2022: 13 · 2021: 22 · 2020: 16 · 2019: 13
- FWCI
- 12.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Centers for Disease Control and Prevention (U54CK000484)
- Agency for Healthcare Research and Quality (K08HS025008)
- National Institute of General Medical Sciences (R35GM119519)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
- Keywords
- sepsis surveillance, Sepsis-3, SOFA score, organ dysfunction, electronic health records, sepsis prevalence, in-hospital mortality, diagnostic agreement, adult sepsis, sepsis definitions, lactate, vasopressors, mechanical ventilation, renal failure, thrombocytopenia, bilirubin
- MeSH terms
- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Population Surveillance, Retrospective Studies, United States, Prevalence, Sepsis, Electronic Health Records, Organ Dysfunction Scores
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