Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

New, Useful Criteria for Assessing the Evidence of Infection in Sepsis Research

Mellhammar, Lisa LU ; Elén, Sixten LU orcid ; Ehrhard, Simone ; Bouma, Hjalmar ; Ninck, Lorenz ; Muntjewerff, Eva ; Wünsch, Daniel ; Bloos, Frank ; Malmström, Erik LU and Linder, Adam LU (2022) In Critical Care Explorations 4(5).
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... (More)

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 κ 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 (κ = 0.62 [95% CI, 0.59-0.65] vs κ = 0.43 [95% CI, 0.39-0.47], respectively) and the diagnosis on hospital discharge (κ = 0.57 [95% CI, 0.53-0.61] vs κ = 0.43 [95% CI, 0.39-0.47], respectively). The interobserver agreement for the LMCI was evaluated in 91 patients, with agreement in 77%, κ = 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 (κ = 0.65 [95% CI, 0.60-0.70] vs κ = 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 have the potential to facilitate more comparable sepsis research and exclude sepsis mimics from clinical studies, thus improving and simplifying sepsis research.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
definitions, diagnosis, infectious disease medicine, sepsis
in
Critical Care Explorations
volume
4
issue
5
article number
e0697
pages
10 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85149381341
  • pmid:35620771
ISSN
2639-8028
DOI
10.1097/CCE.0000000000000697
language
English
LU publication?
yes
additional info
Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.
id
f3d71ae0-0739-4ac4-bf22-8a816bafd37e
date added to LUP
2025-11-13 10:15:38
date last changed
2025-11-14 04:02:56
@article{f3d71ae0-0739-4ac4-bf22-8a816bafd37e,
  abstract     = {{<p>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.</p><p>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.</p><p>SETTING: Four academic hospitals in Sweden, Switzerland, the Netherlands, and Germany.</p><p>PATIENTS: A total of 934 adult patients with suspected infection or suspected sepsis.</p><p>INTERVENTIONS: None.</p><p>MEASUREMENTS AND MAIN RESULTS: Agreement of infection site classification was measured using the LMCI with Cohen κ 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.</p><p>MEASUREMENTS AND MAIN RESULTS: The precision of the LMCI varied according to the applied reference. LMCI performed better than the Calandra and Cohen definitions (κ = 0.62 [95% CI, 0.59-0.65] vs κ = 0.43 [95% CI, 0.39-0.47], respectively) and the diagnosis on hospital discharge (κ = 0.57 [95% CI, 0.53-0.61] vs κ = 0.43 [95% CI, 0.39-0.47], respectively). The interobserver agreement for the LMCI was evaluated in 91 patients, with agreement in 77%, κ = 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 (κ = 0.65 [95% CI, 0.60-0.70] vs κ = 0.29 [95% CI, 0.24-0.33], respectively).</p><p>CONCLUSIONS: The LMCI is useful criterion of infection that is intended for sepsis research, in and outside of the ICU. Useful criteria for infection have the potential to facilitate more comparable sepsis research and exclude sepsis mimics from clinical studies, thus improving and simplifying sepsis research.</p>}},
  author       = {{Mellhammar, Lisa and Elén, Sixten and Ehrhard, Simone and Bouma, Hjalmar and Ninck, Lorenz and Muntjewerff, Eva and Wünsch, Daniel and Bloos, Frank and Malmström, Erik and Linder, Adam}},
  issn         = {{2639-8028}},
  keywords     = {{definitions; diagnosis; infectious disease medicine; sepsis}},
  language     = {{eng}},
  number       = {{5}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Critical Care Explorations}},
  title        = {{New, Useful Criteria for Assessing the Evidence of Infection in Sepsis Research}},
  url          = {{http://dx.doi.org/10.1097/CCE.0000000000000697}},
  doi          = {{10.1097/CCE.0000000000000697}},
  volume       = {{4}},
  year         = {{2022}},
}