Sepsis Types and Descriptions
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, characterized by an increase in the Sequential Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with hospital mortality greater than 10%. 1
Types of Sepsis
1. Sepsis
- Definition: Life-threatening organ dysfunction caused by a dysregulated host response to infection 2, 1
- Clinical Features:
- Organ dysfunction in one or more systems
- Abnormal vital signs (tachycardia, tachypnea)
- Altered mental status
- Decreased urine output
- Elevated lactate levels
- Assessment: Measured by an increase in SOFA score ≥2 points 1
2. Septic Shock
- Definition: A subset of sepsis with circulatory, cellular, and metabolic abnormalities profound enough to substantially increase mortality 1
- Clinical Features:
- Persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg
- Serum lactate >2 mmol/L (>18 mg/dL) despite adequate fluid resuscitation
- Associated with hospital mortality rates exceeding 40% 1
Organ Systems Affected in Sepsis
Respiratory System
- Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) occur in 25-42% of sepsis patients 1
- Manifests as hypoxemia and respiratory failure
Cardiovascular System
- Hypotension
- Myocardial depression
- Microcirculatory dysfunction
Renal System
- Acute kidney injury
- Decreased urine output
- Electrolyte abnormalities
Neurological System
- Altered mental status
- Confusion or delirium
- Decreased Glasgow Coma Scale score
Hepatic System
- Elevated liver enzymes
- Hyperbilirubinemia
- Coagulation abnormalities
Coagulation System
- Thrombocytopenia
- Elevated D-dimer
- Disseminated intravascular coagulation (DIC)
Assessment Tools for Sepsis
SOFA Score
- Comprehensive assessment of six organ systems:
- Respiratory (PaO2/FiO2 ratio)
- Cardiovascular (MAP, vasopressor requirements)
- Hepatic (bilirubin)
- Coagulation (platelets)
- Renal (creatinine, urine output)
- Neurological (Glasgow Coma Scale)
- Maximum score of 24 points 1
Quick SOFA (qSOFA)
- Rapid bedside assessment with three parameters:
- Altered mental status
- Systolic blood pressure ≤100 mmHg
- Respiratory rate ≥22/min
- Score ≥2 indicates high risk for poor outcomes 1
National Early Warning Score 2 (NEWS2)
- Evaluates six physiological parameters:
- Respiratory rate
- Oxygen saturation
- Systolic blood pressure
- Pulse rate
- Level of consciousness
- Temperature
- Scores range from 0 (very low risk) to ≥7 (high risk) 1
Risk Stratification and Management
High-Risk Patients (qSOFA ≥2 or NEWS2 ≥7)
- Require broad-spectrum antibiotics within 1 hour
- IV fluid bolus (30 ml/kg crystalloid) for hypotension
- Monitoring every 30 minutes 1
Moderate-Risk Patients (NEWS2 5-6)
- Antibiotics within 3 hours
- IV fluids as needed
- Hourly monitoring 1
Low-Risk Patients (NEWS2 1-4)
- Antibiotics within 6 hours
- Monitoring every 4-6 hours 1
Clinical Recognition of Sepsis
First aid providers should consider infection in any person with an acute illness associated with abnormal signs or symptoms, and urgently seek medical evaluation 2. Signs and symptoms to watch for include:
- Temperature abnormalities (fever or hypothermia)
- Neurologic changes (altered mental status, slurred speech)
- Musculoskeletal symptoms (severe muscle pain, shivering)
- Urologic issues (decreased urine output)
- Respiratory problems (rapid breathing, breathlessness)
- Skin changes (clammy/sweaty, new rash, mottled or discolored)
- Cardiovascular abnormalities (elevated heart rate)
- Gastrointestinal symptoms (nausea, vomiting, diarrhea)
- Subjective feeling of being very unwell 2
Important Considerations
- Early recognition and treatment are crucial for improving outcomes, as delayed recognition increases mortality 1
- Regular reassessment using scoring systems enables monitoring of patient condition and disease progression 1
- Sepsis is a time-dependent condition requiring prompt recognition and standardized treatment 3
- Despite advances in management, sepsis remains a major global health concern with high mortality rates 4, 5
Understanding the different types of sepsis and their clinical manifestations is essential for early recognition and appropriate management, which significantly impacts patient outcomes.