Table 10.13-1. Definitions and criteria for the diagnosis of sepsis and septic shock

Consensus criteria

Previous (1991, 2001)

Current (2016)

Sepsis

Systemic inflammatory response caused by infection. Criteria for SIRS are considered to be met if ≥2 of the following occur:

1) Body temperature >38°C or <36°C

2) Heart rate >90/mina

3) Respiratory rate >20/min or PaCO2 <32 mm Hg

4) Leukocyte count >12×109/L or <4×109/L or >10% immature neutrophil

Life-threatening organ dysfunction caused by dysregulated host response to infection, which causes organ damage (corresponds to the previous concept of severe sepsis)

 

Severe sepsis

Sepsis causing failure or severe malfunction of ≥1 organ/system (corresponds to the current concept of sepsis)

Sepsis, as above

Organ dysfunction

– Cardiovascular system: Hypotension (SBP <90 mm Hg, MAP <70 mm Hg, or SBP drop >40 mm Hg)

– Respiratory system: PaO2/FiO2 <300 mm Hg (<200 mm Hg in patients with primary diseases of respiratory tract)

– Kidneys: Urine output <0.5 mL/kg/h over >2 h with adequate fluid intake/resuscitation or serum creatinine increase by >0.5 mg/dL (44.2 micromol/L)

– Metabolism: Elevated serum lactate

– Hemostasis: Platelet count <100×109/L or INR >1.5

– Liver: Serum bilirubin >34.2 micromol/L (2 mg/dL)

– CNS: Features of encephalopathy (anxiety, confusion, agitation, delirium, coma)

Patient with suspected or documented infection and ≥2 points increase from baseline on SOFA (see text)b

 

Septic shock

Severe sepsis with acute circulatory failure characterized by persistent hypotension (SBP <90 mm Hg, MAP <65 mm Hg or decrease in SBP by >40 mm Hg) despite adequate fluid resuscitation (thus requiring use of vasoconstrictive drugs)

Subset of sepsis with underlying circulatory and cellular metabolism abnormalities profound enough to substantially increase mortality. Clinical criteria include presence of sepsis and vasopressor therapy needed to elevate MAP ≥65 mm Hg and lactate >2 mmol/L (18 mg/dL) despite adequate fluid resuscitation

Scale proposed for early identification of patients at risk of death

Not specified; SIRS, organ dysfunction, and extended criteria for diagnosis of sepsis were used

qSOFA: ≥2 of:

1) Disturbance of consciousness

2) SBP ≤100 mm Hg

3) Respiratory rate ≥22/min

a This may not occur in patients receiving beta-blockers.

b In patients without acute organ dysfunction the SOFA score is usually 0.

Based on Intensive Care Med. 2003;29(4):530-8 and JAMA. 2016 23;315(8):801-10.

CNS, central nervous system; FiO2, fraction of inspired oxygen; INR, international normalized ratio; MAP, mean arterial pressure; PaCO2, partial pressure of carbon dioxide in arterial blood; PaO2, arterial partial pressure of oxygen; qSOFA, quick sequential organ failure assessment; SBP, systolic blood pressure; SIRS, syndrome of systemic inflammatory response; SOFA, sequential organ failure assessment.