Unifying Concepts

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 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.

Infection 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.



  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: Aug 02, 2005.
Update: Sep 28, 2014.

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