LAUSR

Can I thank Dr Rodriguez and colleagues for engendering debate and discussion on the new Sepsis-3 definitions. This is a valuable exercise not only to raise queries and thoughts, but also to clarify misconceptions. Below, using a combination of science and data, I shall gently pick apart each of their assertions to demonstrate the flaws and inconsistencies in their arguments. The main reason why SIRS was not included in the operationalization of the new sepsis definition was actually based on pathophysiology. The SIRS criteria are not particularly good in distinguishing a normal and appropriate host response to an infection from an inappropriate response resulting in a more serious infection. A bad cold will thus qualify as ‘sepsis’ in the old terminology if accompanied, for example, by fever >38 C and a heart rate above 90 bpm. The new definition however describes a dysregulated, lifethreatening host response that results in organ dysfunction. Whereas few patients die from a cold, despite having two or more SIRS criteria, a SOFA score ≥2 related to the acute episode does indeed represent organ dysfunction and is associated with a >10% risk of dying. The semantic argument posed by Rodriguez et al. of 7in-8 patients admitted to ICU with infection-related organ failure having SIRS misses the point. Rather, the 1-in-8 who did not have the requisite SIRS criteria would not have qualified as having sepsis under the old definition despite having