Diagnostic Criteria for Sepsis

Infection,a documented or suspected, and some of the following:b

General variables

· Fever (core temperature >38.3°C)

· Hypothermia (core temperature <36°C)

· Heart rate >90 /min or >2 SD above the normal value for age

· Tachypnea

· Altered mental status

· Significant edema or positive fluid balance (>20 mL/kg over 24 hrs)

· Hyperglycemia (plasma glucose >120 mg/dL or 7.7 mmol/L) in the absence of diabetes

Inflammatory variables

· Leukocytosis (WBC count >12,000 /mm3)

· Leukopenia (WBC count <4000 /mm3)

· Normal WBC count with >10% immature forms

· Plasma C-reactive protein >2 SD above the normal value

· Plasma procalcitonin >2 SD above the normal value

Hemodynamic variables

· Arterial hypotensionb (SBP <90 mm Hg, MAP <70, or an SBP decrease >40 mm Hg in adults or <2 SD below normal for age)

· SvO2 >70%b

· Cardiac index (CI) >3.5 L.min-1.M-23

Organ dysfunction variables

· Arterial hypoxemia (PaO2/FIO2 <300)

· Acute oliguria (urine output <0.5 mL.kg-1.hr-1 or 45 mmol/L for at least 2 hrs)

· Creatinine increase >0.5 mg/dL

· Coagulation abnormalities (INR >1.5 or aPTT >60 secs)

· Ileus (absent bowel sounds)

· Thrombocytopenia (platelet count <100,000 /mm3)

· Hyperbilirubinemia (plasma total bilirubin >4 mg/dL or 70 mmol/L)

Tissue perfusion variables

· Hyperlactatemia (>1 mmol/L)

· Decreased capillary refill or mottling

WBC, white blood cell; SBP, systolic blood pressure; MAP, mean arterial blood pressure; SvO2, mixed venous oxygen saturation; INR, international normalized ratio; aPTT, activated partial thromboplastin time.

aInfection defined as a pathologic process induced by a microorganism;

bSvO2 sat >70% is normal in children (normally, 75–80%), and CI 3.5–5.5 is normal in children; therefore, NEITHER should be used as signs of sepsis in newborns or children;

cdiagnostic criteria for sepsis in the pediatric population are signs and symptoms of inflammation plus infection with hyper- or hypothermia (rectal temperature >38.5 or < 35°C), tachycardia (may be absent in hypothermic patients), and at least one of the following indications of altered organ function: altered mental status, hypoxemia, increased serum lactate level, or bounding pulses.

 

 

References:

  1. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003 Apr;31(4):1250-6. [Medline]
  2. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013 Aug 29;369(9):840-51. [Medline]

Created: August 02, 2005

print