New, Useful Criteria for Assessing the Evidence of Infection in Sepsis Research
type: Article
item type: journalArticle
is part of: Crit Care Explor
authors: Person
  surname: Mellhammar
  given name: L.
authors: Person
  surname: Elen
  given name: S.
authors: Person
  surname: Ehrhard
  given name: S.
authors: Person
  surname: Bouma
  given name: H.
authors: Person
  surname: Ninck
  given name: L.
authors: Person
  surname: Muntjewerff
  given name: E.
authors: Person
  surname: Wunsch
  given name: D.
authors: Person
  surname: Bloos
  given name: F.
authors: Person
  surname: Malmstrom
  given name: E.
authors: Person
  surname: Linder
  given name: A.
subject: definitions
subject: diagnosis
subject: infectious disease medicine
subject: interest.
subject: sepsis
abstract: OBJECTIVES: The Sepsis-3 definition states the clinical criteria for sepsis but lacks clear definitions of the underlying infection. To address the lack of applicable definitions of infection for sepsis research, we propose new criteria, termed the Linder-Mellhammar criteria of infection (LMCI). The aim of this study was to validate these new infection criteria. DESIGN: A multicenter cohort study of patients with suspected infection who were admitted to emergency departments or ICUs. Data were collected from medical records and from study investigators. SETTING: Four academic hospitals in Sweden, Switzerland, the Netherlands, and Germany. PATIENTS: A total of 934 adult patients with suspected infection or suspected sepsis. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Agreement of infection site classification was measured using the LMCI with Cohen kappa coefficient, compared with the Calandra and Cohen definitions of infection and diagnosis on hospital discharge as references. In one of the cohorts, comparisons were also made to adjudications by an expert panel. A subset of patients was assessed for interobserver agreement. MEASUREMENTS AND MAIN RESULTS: The precision of the LMCI varied according to the applied reference. LMCI performed better than the Calandra and Cohen definitions (kappa = 0.62 [95% CI, 0.59-0.65] vs kappa = 0.43 [95% CI, 0.39-0.47], respectively) and the diagnosis on hospital discharge (kappa = 0.57 [95% CI, 0.53-0.61] vs kappa = 0.43 [95% CI, 0.39-0.47], respectively). The interobserver agreement for the LMCI was evaluated in 91 patients, with agreement in 77%, kappa = 0.72 (95% CI, 0.60-0.85). When tested with adjudication as the gold standard, the LMCI still outperformed the Calandra and Cohen definitions (kappa = 0.65 [95% CI, 0.60-0.70] vs kappa = 0.29 [95% CI, 0.24-0.33], respectively). CONCLUSIONS: The LMCI is useful criterion of infection that is intended for sepsis research, in and outside of the ICU. Useful criteria for infection…
date: 2022-05-28
pages: e0697
coverage: 35620771

Crit Care Explor
type: Journal
volume: 4
number: 5
identifier: DOI 10.1097/CCE.0000000000000697
identifier: ISSN 2639-8028 (Electronic) 2639-8028 (Linking)