Does leukocytosis (elevated white blood cell count) with hypotension (low blood pressure) in the absence of fever, tachycardia (rapid heart rate), or tachypnea (rapid breathing rate) meet the criteria for Systemic Inflammatory Response Syndrome (SIRS) or sepsis?

From the Guidelines

Leukocytosis with hypotension without fever, tachycardia, or tachypnea does not meet criteria for Systemic Inflammatory Response Syndrome (SIRS), but it could potentially indicate sepsis if the hypotension is due to infection, as per the Sepsis-3 criteria 1.

Definition of Sepsis

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, with organ dysfunction represented by an increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more 1.

SIRS Criteria

Traditionally, SIRS requires at least two of the following criteria: temperature >38°C or <36°C, heart rate >90 beats/minute, respiratory rate >20 breaths/minute or PaCO2 <32 mmHg, and white blood cell count >12,000/mm³ or <4,000/mm³ or >10% immature bands.

Hypotension and Sepsis

Hypotension (systolic blood pressure <90 mmHg or mean arterial pressure <65 mmHg) can represent organ dysfunction, and if there is a suspected or confirmed infection causing the hypotension, this would meet the current Sepsis-3 criteria regardless of SIRS criteria 1.

Clinical Judgment

The absence of fever, tachycardia, and tachypnea doesn't rule out sepsis, especially in elderly patients, immunocompromised individuals, or those on medications that mask inflammatory responses. Clinical judgment is essential, and further evaluation for source of infection and additional organ dysfunction markers would be necessary for definitive diagnosis 1. Some key points to consider:

• The new definition of sepsis suggests that patients with at least 2 of these 3 clinical variables: Glasgow Coma Scale score of 13 or less, systolic blood pressure of 100 mm Hg or less, and respiratory rate 22/min or greater (quick SOFA - qSOFA) may be prone to sepsis 1.
• Early recognition of sepsis is a general principle of sepsis management and is very important in low- and middle-income countries where the priorities for improving quality of care of critically ill patients are different 1.
• The use of definition versus threshold will be evident throughout the management of sepsis, with therapeutic targets or typical thresholds for the reversal of hypotension, such as the use of vasopressors to maintain a mean arterial pressure of 65 mm Hg or greater 1.

From the Research

Systemic Inflammatory Response Syndrome (SIRS) and Sepsis Criteria

• The provided studies do not directly address the question of whether leukocytosis with hypotension in the absence of fever, tachycardia, or tachypnea meets the criteria for SIRS or sepsis 2, 3, 4, 5, 6.
• However, it is known that SIRS is characterized by two or more of the following conditions: body temperature greater than 38°C or less than 36°C, heart rate greater than 90 beats per minute, respiratory rate greater than 20 breaths per minute or PaCO2 less than 32 mmHg, and white blood cell count greater than 12,000 cells/mm³ or less than 4,000 cells/mm³ 6.
• Sepsis is defined as SIRS in response to a suspected or confirmed infection 6.
• Septic shock is a subset of sepsis with persistent hypotension despite fluid resuscitation and tissue hypoperfusion 2.

Hypotension and Sepsis

• Hypotension is a key component of septic shock, and its management is crucial in the treatment of sepsis 2, 3, 4, 5.
• The provided studies focus on the management of hypotension in sepsis, including fluid resuscitation and vasopressor therapy 2, 3, 4, 5.
• However, they do not specifically address the question of whether leukocytosis with hypotension in the absence of other SIRS criteria meets the criteria for SIRS or sepsis.

Conclusion Not Applicable

As per the given instructions, a conclusion section is not applicable in this response.

Relevant Information

• The diagnosis of sepsis and septic shock is complex and requires careful consideration of various clinical and laboratory parameters 2, 3, 4, 5, 6.
• The provided studies highlight the importance of early recognition and treatment of sepsis and septic shock, but do not provide a clear answer to the question regarding leukocytosis with hypotension in the absence of other SIRS criteria 2, 3, 4, 5, 6.