Sepsis, the Sepsis Syndrome, Multi-Organ Failure: A Plea for Comparable Definitions
Authors: Roger C. Bone
Journal: Annals of Internal Medicine (1991)

Editorials15 February 1991Sepsis, the Sepsis Syndrome, Multi-Organ Failure: A Plea for Comparable DefinitionsRoger C. Bone, MDRoger C. Bone, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-4-332 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptPrecision in language is no trivial matter. Considerable confusion arises when terms are defined differently by different clinical subspecialties, or even within a given field. Such is the predicament that has arisen regarding the related, but overlapping terms used for the various degrees of severe clinical infection. Everyone has a vague notion of what the terms bacteremia, septicemia, sepsis, the sepsis syndrome, and septic shock mean. Too often, however, these words are used interchangeablyin speech and in the professional literature, which can lead to considerable bewilderment. Because clinical protocols are based on specific criteria understood by the developers of a...References1. BoneFisherClemmerSlotmanMetzBalk RCTGCR. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med. 1987;317:353-8. CrossrefGoogle Scholar2. SprungCaralisMarcial CPE. The effects of high-dose corticosteroids in patients with septic shock. A prospective, controlled study. N Engl J Med. 1984;311:1137-43. CrossrefMedlineGoogle Scholar3. . Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of sepsis. N Engl J Med. 1987;317:659-65. CrossrefMedlineGoogle Scholar4. Stedman's Medical Dictionary, 25th ed. Baltimore: Williams & Wilkins;1990. Google Scholar5. KregerCravenMcCabe BDW. Gram-negative bacteremia. IV. Re-evaluation of clinical features and treatment in 612 patients. Am J Med. 1980;68:344-55. CrossrefMedlineGoogle Scholar6. ParkerParrillo MJ. Septic shock. Hemodynamics and pathogenesis. JAMA. 1983;250:3324-7. CrossrefMedlineGoogle Scholar7. KnausDraperWagnerZimmerman WEDJ. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29. CrossrefMedlineGoogle Scholar8. BellCoalsonSmithJohanson RJJW. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med. 1983;99:293-8. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Roger C. Bone, MDAffiliations: Rush-Presbyterian-St. Luke's Medical Center Chicago, IL 60612 PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byWhat Is Cytokine Storm?Safety assessment of compliant, highly invasive, lipid A-altered, O-antigen-defected Salmonella strains as prospective vaccine delivery systemsCytokine Storm—Definition, Causes, and ImplicationsThe End of “One Size Fits All” Sepsis Therapies: Toward an Individualized ApproachOuter membrane vesicles as biomimetic vaccine carriers against infections and cancersLocal and systemic effects of interleukin‐6 (IL‐6) in inflammation and cancerReflections on Critical Care’s Past, Present, and FutureHealthcare-Associated Stenotrophomonas maltophilia Bacteraemia: Retrospective Evaluation of Treatment and OutcomeOutcomes prediction in longitudinal data: Study designs evaluation, use case in ICU acquired sepsisQuantifying misclassification and bias errors due to hierarchical sepsis scores in real-time sepsis diagnosisIn vitro Impact of Yeast Expressed Hybrid Peptide CATH-2TP5 as a Prophylactic Measure Toward Sepsis and InflammationPhage therapy efficacy: a review of the last 10 years of preclinical studiesA Coordinated Response at The Transcriptome and Interactome Level is Required to Ensure Uropathogenic Escherichia coli Survival during BacteremiaAntioxidant and Cardioprotective Effects of EPA on Early Low-Severity Sepsis through UCP3 and SIRT3 Upholding of the Mitochondrial Redox PotentialDipeptidase-1 Is an Adhesion Receptor for Neutrophil Recruitment in Lungs and LiverPulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 casesDiagnosis and Management of Sepsis and Septic Shock: An Evidence-Based ReviewEffect of TNF-α concentration on selected clinical parameters of swine after burnsA prospective multicentre study of the epidemiology and outcomes of bloodstream infection in cirrhotic patientsSafety implication of Salmonella based Brucella vaccine candidate in mice and in vitro human cell cultureSepsis grave y shock séptico en urgenciasValue of Serum Cholinesterase Activity in the Diagnosis of Septic Shock Due to Bacterial InfectionsDifferences in reported sepsis incidence according to study design: a literature reviewCurrent Clinical Controversies in the Management of SepsisIntegrated approach to colorectal anastomotic leakage: Communication, infection and healing disturbancesCorticosteroids for treating sepsisLactobacillus plantarum CECT 7315/7316 intake modulates the acute and chronic innate inflammatory responseSepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensusCoagulase-negative staphylococcal bacteremia: risk factors for mortality and impact of initial appropriate antimicrobial therapy on outcomeIncidence and impact outcome of pulmonary embolism in critically ill patients with severe exacerbation of chronic obstructive pulmonary diseasesMorin hydrate augments phagocytosis mechanism and inhibits LPS induced autophagic signaling in murine macrophageT helper type 2-polarized invariant natural killer T cells reduce disease severity in acute intra-abdominal sepsisDoes Change of Catecholamine Use Improve the Outcome of Patients With Shock Admitted to Intensive Care Unit?A History of Intensive Care MedicineThe complex pathogenesis of bacteremiaGram-positive and gram-negative bacterial toxins in sepsisNeutropenia febbrile e Pronto SoccorsoEfficacy of Corticosteroid Therapy in Severe Decompensation of Chronic Obstructive Pulmonary Disease Requiring Mechanical VentilationEpidemiological and clinical study on scorpionism in French GuianaProcalcitonin in sepsis and bacterial infectionsThe Systemic Inflammatory Response Syndrome in Patients With ST-Segment Elevation Myocardial Infarction*Usefulness of Urinary Immune Biomarkers in the Evaluation of Neonatal SepsisBenchmarking the Incidence and Mortality of Severe Sepsis in the United States*Neutropénie fébrile et urgencesPilot Study Comparing Sepsis Management with and without Electronic Clinical Practice Guidelines in an Academic Emergency DepartmentIL-6 trans-signaling promotes pancreatitis-associated lung injury and lethalityRenal Cell Apoptosis and New Treatment Options in Sepsis-Induced Acute Kidney InjurySeptic Complications During Percutaneous Nephrolithotomy (PCNL)Bacterial Infections and CeramideProtective Effect of Phosphatidylcholine on Lipopolysaccharide-Induced Acute Inflammation in Multiple Organ InjuryHisterectomía obstétrica por sepsis en el puerperioInfections of the Urinary TractUse of Heptaminol Hydrochloride for Catecholamine Weaning in Septic ShockNeutropénie fébrile dans les services d’urgence en France: résultats d’une enquête de pratique multicentrique prospectiveHigh plasma cytokine levels, white matter injury and neurodevelopment of high risk preterm infants: Assessment at two yearsPerfil microbiológico de la Infecciones en Unidades de Cuidados Intensivos de Colombia (EPISEPSIS Colombia)Microbiological profile of infections in the Intensive Care Units of Colombia (EPISEPSIS Colombia)Intensive care unit—acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shockNafamostat prevents hypothermia and improves survival time after administration of lipopolysaccharide in a mouse surgical modelPurine nucleotides reduce superoxide production by nitric oxide synthase in a murine sepsis modelSevere head injury among children: Prognostic factors and outcomePotential clinical benefit of the in situ hybridization method for the diagnosis of sepsisShock sépticoShock setticoInteraction of CD44 and hyaluronan is the dominant mechanism for neutrophil sequestration in inflamed liver sinusoidsDelirium, Sleep, and Mental Health Disturbances in Critical IllnessChoc septiqueAcquired Deficit of Antithrombin and Role of Supplementation in Septic Patients During Continuous Veno-Venous HemofiltrationNetting bacteria in sepsisPlatelet TLR4 activates neutrophil extracellular traps to ensnare bacteria in septic bloodTolerance of Mice to Lipopolysaccharide is Correlated with Inhibition of Caspase-3-mediated Apoptosis in Mouse Liver CellsClinical prediction rules for bacteremia and in-hospital death based on clinical data at the time of blood withdrawal for culture: an evaluation of their development and useDisparidad en los criterios para incluir pacientes con sepsis neonatal en estudios médicos científicos. ¿Nadamos en un mar sin límites?La méningite post-traumatique : incidence, microbiologie et pronosticTHE VALUE OF SEPSIS DEFINITIONS IN DAILY ICU-PRACTICEAgression cérébrale au cours du sepsis sévèreSedative and Analgesic Medications: Risk Factors for Delirium and Sleep Disturbances in the Critically IllThe etiology of sepsis: turned inside outInterleukin 6 is a prognostic indicator of outcome in severe intra-abdominal sepsisSepsis: Still Going StrongDelirium: acute cognitive dysfunction in the critically illP- and E-Selectin Blockade Can Control Bacterial Translocation and Modulate Systemic Inflammatory ResponsePrevalence of hospital-acquired infection in a Tunisian hospitalLocal coordination verses systemic disregulation: complexities in leukocyte recruitment revealed by local and systemic activation of TLR4 in vivoThe effects of selective nitric oxide synthase blocker on survival, mesenteric blood flow and multiple organ failure induced by zymosan1In vivo quercitrin anti-inflammatory effect involves release of quercetin, which inhibits inflammation through down-regulation of the NF-κB pathwayMonitoring Therapeutic Interventions in Critically Ill Septic PatientsCorticosteroids for treating severe sepsis and septic shockImpact of High Volume Hemofiltration on Hemodynamic Disturbance and Outcome during Septic ShockCutting Edge: An Endogenous Pathway to Systemic Inflammatory Response Syndrome (SIRS)-Like Reactions through Toll-Like Receptor 4Relationship of pulmonary artery catheter use to mortality and resource utilization in patients with severe sepsis*PKCϵ is involved in JNK activation that mediates LPS-induced TNF-α, which induces apoptosis in macrophagesHistamine downregulates CD14 expression via H2 receptorson human monocytesCurrent Epidemiology of Septic ShockEvidence that aminoguanidine inhibits endotoxin-induced bacterial translocationBacteremia and SepsisResource Utilization Among Patients With Sepsis SyndromeLipopolysaccharide-Induced Leukocyte-Endothelial Cell Interactions: A Role for CD14 Versus Toll-Like Receptor 4 Within MicrovesselsTranscriptional Activation of the BNP Gene by Lipopolysaccharide is Mediated Through GATA Elements in Neonatal Rat Cardiac MyocytesObstetric Infectious Disease EmergenciesRandomized, controlled clinical trials in sepsis: Has methodological quality improved over time?Alpha-4 Integrin: A Novel Mechanism for Neutrophil-endothelial InteractionAlpha-4 Integrin: A Novel Mechanism for Neutrophil-endothelial InteractionMonitoring the Systemic Circulation in Sepsis with MicroelectrodesPharmacokinetic and Pharmacodynamic Considerations When Treating Patients with Sepsis and Septic ShockSepsis: State of the artFunctional α4-integrin: A newly identified pathway of neutrophil recruitment in critically ill septic patientsSepsis DefinitionsIntensive Care Management in Abdominal Surgical Patients with Septic ComplicationsAu vu des études cliniques, quels sont les arguments pour l'efficacité des corticoïdes au cours du choc septique?Selecting donors of platelets for refractory patientson the basis of HLA antibody specificityDeferoxamine reduces tissue injury and lethality in LPS-treated micePathophysiology of septic encephalopathy: A reviewLPS induces apoptosis in macrophages mostly through the autocrine production of TNF-αLPS induces apoptosis in macrophages mostly through the autocrine production of TNF-αCorticosteroid treatment for septic shockCompartmentalised inducible nitric-oxide synthase activity in septic shockInterobserver Variability in Applying a Radiographic Definition for ARDSContinuous plasmafiltration in sepsis syndromePlasmafiltration in sepsis: Removing the evil humorsThe effects of bosentan, aminoguanidine and l-canavanine on mesenteric blood flow, spleen and liver in endotoxaemic miceP-selectin and ICAM-1 mediate endotoxin-induced neutrophil recruitment and injury to the lung and liverUSING LARGE-SCALE DATABASES TO MEASURE OUTCOMES IN CRITICAL CAREOutcomes Research in Critical CareTHE EPIDEMIOLOGY OF BACTERIAL SEPSISTumor necrosis factor-α and lipopolysaccharide induce apoptotic cell death in bovine glomerular endothelial cellsEvaluation of interleukin-6, tumour necrosis factor-α and interleukin-1β for early diagnosis of neonatal sepsisEffects of epinephrine, norepinephrine, or the combination of norepinephrine and dobutamine on gastric mucosa in septic shockRandomized clinical outcome study of critically ill patients given glutamine-supplemented enteral nutritionMetabolism and O2 Consumption in Trauma and SepsisClinical trial of in-situ hybridization method for the rapid diagnosis of sepsisPitfalls in the care of the injured patientImpaired pressor sensitivity to noradrenaline in septic shock patients with and without impaired adrenal function reserveReduced mortality from septic shock-Lessons for the futureThe Management of Sepsis: A Practical ReviewThe Management of Sepsis: A Practical ReviewThe Hemodynamic Derangements in SepsisReversal of late septic shock with supraphysiologic doses of hydrocortisoneFever and hypothermia: two adaptive thermoregulatory responses to systemic inflammationCan Hospital Discharge Diagnosis be used for Surveillance of Bacteremia? A Data Quality Study of a Danish Hospital Discharge RegistryInterferon-gamma in the prevention of severe burn-related infectionsBacteremia and SepsisDo We Really Know the Epidemiology and Clinical Course of Sepsis?Epidemiology and Clinical Course of SepsisThe Complexities of Sepsis and Organ DysfunctionMicrobiological considerations in intensive careThe immune system and the kidneyLipopolysaccharide Induces Disseminated Endothelial Apoptosis Requiring Ceramide GenerationA Rapid Qualitative Assay to Detect Circulating Endotoxin Can Predict the Development of Multiorgan DysfunctionSix-month outcome of critically ill patients given glutamine-supplemented parenteral nutritionUtilization of a chromogenic Limulus amebocyte lysate blood assay in a multi-center study of sepsisIncreased Prevalence of HIV-2 Infection in Hospitalized Patients with Severe Bacterial Diseases in Guinea-BissauSerum erythropoietin levels in patients with sepsis and septic shockThe Relationship of the ACCP/SCCM Consensus Conference Classification of Sepsis to Mortality and Multiorgan Dysfunction among Medical ICU PatientsRationale, design and performance of a clinical trial to investigate interferon-gamma (imukin) in the prophylactic treatment of severe burns-related infections"Sepsis/SIRS," Physiologic Classification, Severity Stratification, Relation to Cytokine Elaboration and Outcome Prediction in Posttrauma Critical IllnessN-acetyl-L-cysteine depresses cardiac performance in patients with septic shockBacteremia due to glucose non-fermenting gram-negative bacilli in patients with hematological neoplasias and solid tumorsTumor necrosis factor alpha (TNF-α) and sepsis: Evidence for a role in host defenseLow lipid concentrations in critical illnessSeptic shock: a case studyImmunotherapy of Severe Sepsis and Septic Shock: Is there a Future?Definition and Pathogenesis of Septic ShockNew Frontiers: Hyperbaric Oxygen Therapy (HBO) in Open Heart Surgery’s ComplicationsRandomized clinical trials in the presence of diagnostic uncertainty: Implications for measures of efficacy and sample sizeThe Italian SEPSIS study: Preliminary results on the incidence and evolution of SIRS, sepsis, severe sepsis and septic shockThe Relevance of Searching for Effects under a Clinical-trial LamppostTreatment of sepsis and septic shock: A reviewSepsis During PregnancySepsis and the systemic inflammatory response syndrome (SIRS)Physiological classification and stratification of illness severity of posttrauma 'sepsis' patients as a basis for randomization of clinical trialsSepsis and septic shockACUTE HYPOTENSION RELATED TO SEPSIS IN THE OBSTETRIC PATIENTEffects of nitric oxide synthase inhibition combined with nitric oxide inhalation in a porcine model of endotoxin shockUse of Nitric Oxide Synthase Inhibitors as a Novel Treatment for Septic ShockRapidly Fatal Outcome of Bacteremic Klebsiella pneumoniae Pneumonia in AlcoholicsENDOTOXAEMIA: RECENT ADVANCES IN PATHOPHYSIOLOGY AND TREATMENTAcetylcysteine as a Cytoprotective Antioxidant in Patients with Severe Sepsis: Potential New Use for an Old DrugInfluence of continuous haemofiltration-related hypothermia on haemodynamic variables and gas exchange in septic patientsGram-Negative Bacterial Sepsis and Sepsis SyndromeThe Polyneuropathy of Critical IllnessSepsis terminology in pediatricsFever and SepticemiaBacteremia and SepsisSepsis and Septic Shock: Update on DefinitionsRole of Tumor Necrosis Factor α in Acute and Chronic Inflammatory Responses: Novel Therapeutic ApproachesUrine Hydrogen Peroxide During Adult Respiratory Distress Syndrome in Patients With and Without SepsisIncidence and Clinical Significance of Positive Blood Cultures in Febrile Episodes of Patients with Hematological MalignanciesA Prospective Study of Continuous Hemodiafiltration in the Management of Severe Acute Renal Failure in Critically III Surgical PatientsAminoguanidine selectively inhibits inducible nitric oxide synthaseAcute pulmonary coccidioidomycosis mimicking bacterial pneumonia and septic shock: A report of two casesDetection and Prevention of Central Venous Catheter-Related InfectionsAntiendotoxin Therapy in SepsisPathogenetic Mechanisms of Septic ShockMechanisms and Management of Septic ShockBCG vaccination and health care workers.Toxic shock syndrome after minor surgery.Toxic shock syndrome after minor surgery.Treatment of Candida albicans fungaemia with fluconazoleWhat's in a name? An acronym or a response?Role of immunomodulator therapy in sepsisThe neurological complications of sepsisThe Role of Respiratory Failure in Multiorgan FailureModels of Endotoxemia in SheepSynovial-type (group II) phospholipase A2 in serum of febrile patients with haematological malignancySEPSIS IN PREGNANCYThe ACCP-SCCM Consensus Conference on Sepsis and Organ FailureDefinitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in SepsisEvaluation of Definitions for SepsisHaemodynamic improvement in refractory septic shock with cortisol replacement therapyHA-1ASepsis and Multiple Organ Failure: Consensus and ControversyHerzkreislaufsystem und MultiorganversagenEpidemiology and Clinical Impact of Gram-negative SepsisSepsis SyndromeCorticosteroids for the Treatment of Septic ShockReplySepsis syndromeThe Pathogenesis of SepsisRoger C. Bone, MDManagement of Septic Shock: Present and FutureJoseph E. Parrillo, MDSeptic shock: pathogenesisDelirium with SepsisCharles E. Schwartz, MDInterférences avec la cascade immuno-inflammatoire 15 February 1991Volume 114, Issue 4Page: 332-333KeywordsBacteremiaBoneInterleukinsSepsisShock ePublished: 1 December 2008 Issue Published: 15 February 1991 PDF downloadLoading ...