Not impressed. It's admirable that we are trying to find sepsis early, and I think we are not going to be very successful. Sepsis is the ultimate chameleon of disease, and we have to be ever vigilant against. it.
How do these tests able to discriminate SIRS from sepsis and from non-infectious etiologies, like trauma, acute pancreatitis etc. Do this tests work with the same sensitivity and specificity or NPV and PPV for bacterial and viral sepsis?
1. Re: discriminating SIRS vs sepsis: the test’s performance is measured against the reference standard of physician adjudication using “Sepsis-2” or “Sepsis-3” criteria (see: circular reasoning in the post ).
2. Re: trauma, these patients were excluded from the validation studies. No information.
3. Re: pancreatitis, other non-infectious inflammatory processes. Many such patients would have been haphazardly included in the validation studies as suspected sepsis and so the test’s performance is dependent on the final physician adjudication (see 1 above).
The critical and perhaps more straightforward aim is to rule out sepsis so that significant effort and expense are not directed unnecessarily to these patients. Looking for a positive diagnosis should probably search closer to the issue's core: bloodstream bacterial invasion.
It reproduces the fundamental mistake: defining a disease by the prognosis.
https://thethoughtfulintensivist.substack.com/p/sepsis-research-is-scary
Not impressed. It's admirable that we are trying to find sepsis early, and I think we are not going to be very successful. Sepsis is the ultimate chameleon of disease, and we have to be ever vigilant against. it.
How do these tests able to discriminate SIRS from sepsis and from non-infectious etiologies, like trauma, acute pancreatitis etc. Do this tests work with the same sensitivity and specificity or NPV and PPV for bacterial and viral sepsis?
1. Re: discriminating SIRS vs sepsis: the test’s performance is measured against the reference standard of physician adjudication using “Sepsis-2” or “Sepsis-3” criteria (see: circular reasoning in the post ).
2. Re: trauma, these patients were excluded from the validation studies. No information.
3. Re: pancreatitis, other non-infectious inflammatory processes. Many such patients would have been haphazardly included in the validation studies as suspected sepsis and so the test’s performance is dependent on the final physician adjudication (see 1 above).
The critical and perhaps more straightforward aim is to rule out sepsis so that significant effort and expense are not directed unnecessarily to these patients. Looking for a positive diagnosis should probably search closer to the issue's core: bloodstream bacterial invasion.