Sepsis Definition and Diagnostic Criteria

HealthCare

-Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.
-Suspected infection and 2 or more qSOFA variables.
-A positive qSOFA score should prompt further evaluation for infection and organ dysfunction. For that, you calculate a SOFA score.
-A SOFA score of  ≥ 2 with suspected infection indicates sepsis.
-A SOFA score of 2 points or more is associated with an in-hospital mortality greater than 10%.
-“Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. ” JAMA 2016

**Note, the term severe sepsis is no longer used by Sepsis 3.  “Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.”

Septic shock:
-Is a subset of sepsis associated with a greater risk of death than sepsis alone.
-Criteria: Vasopressors to maintain a MAP > 65 AND lactate greater than 2 after fluid resuscitation.

The following is the contents of Box 3 from the Jama article below.

New Terms and Definitions

  • Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.

  • Organ dysfunction can be identified as an acute change in total SOFA score ≥2 points consequent to the infection.

    • The baseline SOFA score can be assumed to be zero in patients not known to have preexisting organ dysfunction.

    • A SOFA score ≥2 reflects an overall mortality risk of approximately 10% in a general hospital population with suspected infection. Even patients presenting with modest dysfunction can deteriorate further, emphasizing the seriousness of this condition and the need for prompt and appropriate intervention, if not already being instituted.

  • In lay terms, sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.

  • Patients with suspected infection who are likely to have a prolonged ICU stay or to die in the hospital can be promptly identified at the bedside with qSOFA, ie, alteration in mental status, systolic blood pressure ≤100 mm Hg, or respiratory rate ≥22/min.

  • Septic shock is a subset of sepsis in which underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality.

  • Patients with septic shock can be identified with a clinical construct of sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥65 mm Hg and having a serum lactate level >2 mmol/L (18 mg/dL) despite adequate volume resuscitation. With these criteria, hospital mortality is in excess of 40%.

Abbreviations: MAP, mean arterial pressure; qSOFA, quick SOFA; SOFA: Sequential [Sepsis-related] Organ Failure Assessment.

 

 

Reference

JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287. https://jamanetwork.com/journals/jama/fullarticle/2492881

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