Why LASI did not endorse the new definitions of sepsis published today in JAMA

拉丁美洲全身性感染研究所為何不認可《JAMA》今日發(fā)布的全身性感染新定義

Today, JAMA published the new sepsis definitions, an initiative of the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM). LASI was invited to endorse the document. However, we declined to do so, as did other major American societies such as the American College of Chest Physicians and the American College of Emergency Physicians.

今日，JAMA發(fā)布了由美國危重病醫(yī)學(xué)會(SCCM)及歐洲危重病醫(yī)學(xué)會(ESICM)發(fā)起制定的全身性感染新定義。LASI應(yīng)邀簽署文件。然而，與美國胸內(nèi)科醫(yī)師學(xué)院(ACCP)及美國急診醫(yī)師學(xué)院等美國的其他主要學(xué)會一樣，我們拒絕署名。

We sent a letter today to JAMA with the reasons for our refusal. We decided it was worth sharing the gist of the letter with you; greater details will follow the letter's acceptance.

今天，我們給JAMA編輯部寫信說明了拒絕的理由。我們認為有必要與大家分享信件的要點；待信件被接收后再討論具體細節(jié)。

1. We found it regrettable that the group of experts selected by SSCM and ESICM did not include any member from the low- and middle-income countries (LMIC), as sepsis care is different in these settings. Unfortunately, receiving endorsement from some societies in the LMIC did not solve this issue, since to refuse endorsement could be difficult given the existing political relationships.

我們很遺憾的發(fā)現(xiàn)，SCCM與ESICM挑選的專家組并未包括中低收入國家(LMIC)的任何成員，而在這些地區(qū)全身性感染的治療存在很大差異。遺憾的是，在現(xiàn)有的政治關(guān)系下拒絕署名可能非常困難，因此LMIC的某些學(xué)會可能署名認可這一定義，但這樣并不能解決上述問題。

2. The need of 2 points in SOFA or 2 components of qSOFA to define sepsis will select a more severely ill population. This might be of interest to the more privileged countries, nowadays suffering from over-sensitivity, but it is detrimental to the interests of LMIC, where we are trying to raise awareness about this problem. Patients with hypotension or with a reduced level of consciousness will be classified as 'uncomplicated infection'.

滿足SOFA評分2分或者qSOFA評分2分的患者病情往往更加嚴重。某些發(fā)達國家對這一定義很感興趣，因為它們深受原有標準敏感性過高的損害；然而，這對于LMIC卻是有危害的，因為我們正在設(shè)法提高對這一問題的認知度。低血壓或意識水平降低的患者將歸為“非復(fù)雜性感染”。

3. Any process of improving quality of sepsis care in the LMIC should focus on early detection of possible infection based on SIRS criteria and the presence of any organ dysfunction. So, we cannot agree with the use of qSOFA as a screening tool as suggested by figure 2. These patients would be already too sick.

改進LMIC全身性感染診療質(zhì)量的任何努力，都應(yīng)當(dāng)強調(diào)根據(jù)SIRS及器官功能障礙的標準，早期發(fā)現(xiàn)可能的感染。因此，我們不贊成使用圖2中建議的qSOFA評分做為篩選工具。這些患者可能病情已經(jīng)非常嚴重。

4. Elevated lactate levels (even if > 4 mmol/L) are no longer part of organ dysfunction criteria to define sepsis. According to the new concept, high lactate levels will be used only as one of the criteria to define septic shock. Thus, the new criteria assume that patients with hyperlactatemia and without hypotension have no higher risk of death. We strongly disagree that a patient with lactate higher than 4 mmol/L will have only 'uncomplicated infection'.

乳酸水平升高（即使> 4 mmol/L）不再作為器官功能障礙標準診斷全身性感染。根據(jù)最新概念，乳酸水平升高只是診斷感染性休克的標準之一。因此，新的診斷標準設(shè)想不合并低血壓的高乳酸血癥患者死亡風(fēng)險并不增加。我們強烈反對認為乳酸水平> 4 mmol/L的患者僅為“非復(fù)雜感染”。

We would like to invite you all to a careful reading of the new definitions and to join us in the request for proper reassessment.

希望各位能仔細閱讀新定義，與我們共同要求進行重新評定。

（“來源：CSCCM”）