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Quantifying Risk in Sepsis: A Review of Illness Severity and Organ Dysfunction Scoring

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Conclusion

Well-established clinical risk factors in sepsis include adequacy of antibiotics, presence of underlying disease, source and type of infection, and the presence of shock with MOF. The heterogeneous nature of patients with sepsis and difficulty in reliably describing their disease burden has led to the development of illness severity scoring systems that can be a useful tool for clinicians and investigators.

Advances in illness severity and organ dysfunction scoring systems have allowed investigators and clinicians to use consistent measures of illness to allow comparison between patient populations. There remain a number of areas for potential refinement in this field. When using general risk prediction systems in a novel population of septic patients, one should verify that the models perform adequately for that specific population. Illness severity and organ dysfunction scores provide a useful tool for prognostication and comparison in septic patients, and have played an important role in the advancement of patient care and research in sepsis.

Continuing advances in our understanding of the inflammatory pathways of sepsis will hopefully lead to more effective use of biological markers in sepsis risk prediction. The integration of exciting research in genetic predisposition, coupled with advances in technology allowing more complex analyses (e.g., DNA microarray), will lead to better understanding of the importance of such factors as gender, ethnicity and race from a mechanistic rather than an epidemiological standpoint.

As with other areas of research in critical illness, prognostication in sepsis must take into account patient-centered outcome measures, such as long- term, quality-adjusted survival. Recent preliminary data suggesting that some anti-sepsis interventions may be effective in improving outcome will encourage the development of improved identification of patients likely to benefit from specific interventions. Thus, the near future will hopefully allow prediction of ‘modifiable’ risk, leading to a transition from fatalism in sepsis risk prediction to an environment wherein guided action leads to improved patient outcome.

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Authors
  1. Randy S. Wax
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  2. Derek C. Angus
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  3. William Knaus
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Editor information

Editors and Affiliations

  1. Department of Intensive Care, Erasme University Hospital, Brussels, Belgium

    Jean-Louis Vincent M.D.

  2. Service de Réanimation Polyvalente, Hôpital Saint-Joseph, Paris, France

    Jean Carlet M.D.

  3. Division of Infectious Diseases, The Memorial Hospital of Rhode Island, Pawtucket, RI

    Steven M. Opal M.D.

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© 2002 Kluwer Academic Publishers

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Wax, R.S., Angus, D.C., Knaus, W. (2002). Quantifying Risk in Sepsis: A Review of Illness Severity and Organ Dysfunction Scoring. In: Vincent, JL., Carlet, J., Opal, S.M. (eds) The Sepsis Text. Springer, Boston, MA. https://doi.org/10.1007/0-306-47664-9_6

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  • DOI: https://doi.org/10.1007/0-306-47664-9_6

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-7923-7620-0

  • Online ISBN: 978-0-306-47664-8

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