What are the criteria for diagnosing Sepsis (Systemic Inflammatory Response Syndrome)?

From the Guidelines

Sepsis should be diagnosed using the Sequential Organ Failure Assessment (SOFA) score or the quicker qSOFA criteria, with a focus on early recognition and treatment to reduce mortality and improve quality of life. The qSOFA criteria include respiratory rate ≥22 breaths/minute, altered mental status (Glasgow Coma Scale <15), and systolic blood pressure ≤100 mmHg; having 2 or more of these suggests possible sepsis and warrants further evaluation 1. Septic shock is diagnosed when sepsis is accompanied by persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg and serum lactate >2 mmol/L despite adequate fluid resuscitation 1.

Key Criteria for Sepsis Diagnosis

• Respiratory rate ≥22 breaths/minute
• Altered mental status (Glasgow Coma Scale <15)
• Systolic blood pressure ≤100 mmHg Having 2 or more of these criteria suggests possible sepsis and warrants further evaluation 1.

Importance of Early Recognition and Treatment

Early recognition of sepsis is crucial as mortality increases significantly with delayed treatment 1. Initial management includes:

• Obtaining cultures
• Administering broad-spectrum antibiotics within 1 hour (such as piperacillin-tazobactam 4.5g IV q6h or meropenem 1g IV q8h)
• Providing fluid resuscitation with crystalloids (30 mL/kg within 3 hours)
• Monitoring lactate clearance These criteria help clinicians rapidly identify and treat this life-threatening condition, as each hour of delay in appropriate antibiotic therapy increases mortality by approximately 7-8% 1.

Septic Shock Diagnosis and Management

Septic shock is a subset of sepsis and should 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 1. Norepinephrine is the first-line vasopressor agent used to correct hypotension in the event of septic shock 1.

Quality of Life and Mortality Considerations

The management of sepsis should prioritize reducing morbidity, mortality, and improving quality of life. The use of SOFA and qSOFA criteria, early recognition, and prompt treatment are essential in achieving these goals 1.

From the Research

Sepsis Criteria

• Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection 2
• Septic shock is defined as sepsis with circulatory, cellular, and metabolic dysfunction that is associated with a higher risk of mortality 2
• The measurement of serum lactate has been incorporated into the latest septic shock definition 2
• The Sequential Organ Failure Assessment (original and quick versions) is an important tool for early diagnosis 2

Diagnosis and Management

• Initial evaluation of patients with suspected sepsis includes basic laboratory tests, cultures, imaging studies as indicated, and sepsis biomarkers such as procalcitonin and lactate levels 2
• Fluid resuscitation is the priority in early management, including administering an intravenous crystalloid at 30 mL per kg within the first three hours 2
• Antimicrobial therapy should be initiated early, with most research indicating that it should be started within three hours of presentation 2
• The latest guidelines recommend starting antimicrobials within one hour, but this is controversial 2
• Timely administration of antibiotics is one of the most important interventions in reducing mortality in sepsis 3
• Adjusted odds ratios for in-hospital mortality were lower for patients who received antibiotics within 1 hour compared to those who did not 3

Timing of Antibiotics

• The association between time-to-antibiotics and in-hospital mortality was assessed in patients with sepsis and septic shock 3
• Among patients who received antibiotics within 3 hours, those with septic shock showed a 35% increased risk of mortality for every 1-hour delay in antibiotics 3
• No such trend was observed in patients without shock 3
• A review of existing data found no studies that compared early versus late administration of broad spectrum antibiotics in adult patients with severe sepsis in the pre-intensive care unit admission period 4