Sepsis Outcomes and the Clinical Laboratory
The basis of treatment for severe sepsis and septic shock has been early goal directed hemodynamic therapy (EGDT) that was prescribed in the Surviving Sepsis Campaign guidelines, which were derived more than 10 years ago from a study at a single institution.
In the past year, two multicenter studies involving almost 3000 patients in more than 80 emergency departments were published in the New England Journal of Medicine (ProCESS study, NEJM 2014 Mar 18 Epub and ARISE study, NEJM 2014;371:1496-1506). These studies compared organ dysfunction and mortality in patients randomized to be treated with EGDT or standard care. EGDT did not improve outcomes in either study compared to usual standard care. These studies suggested that more emphasis should be placed on early identification of sepsis and rapid administration of antibiotics than on specific hemodynamic treatments targeted at tissue perfusion.
Clinical laboratories should spend less effort on calling critical values for lactate levels greater than 4.0 mMol/L and more effort on rapid identification of microorganisms. This can be achieved by investing in new technology such as BioFire Diagnostic’s FilmArray® Blood Culture Identification Panel and Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF). These technologies can decrease the time to bacterial identification by 24 hours compared to standard microbiology procedures. Sepsis outcomes will continue to improve if clinical laboratories are given the resources to provide faster, more accurate bacterial identifications and antimicrobial susceptibility results.
