Early Signs of Sepsis
The early warning signs of sepsis include fever (>38.3°C/100.4°F) or hypothermia (<36°C/96.8°F), heart rate >90 beats per minute, respiratory rate >20 breaths per minute, altered mental status, and signs of infection. 1
Vital Sign Abnormalities
Temperature abnormalities:
- Fever >38.3°C/100.4°F or hypothermia <36°C/96.8°F
- Rigors/shivering
- Temperature pattern changes - even subtle variations in temperature patterns may predict sepsis development in critically ill patients 2
Cardiovascular signs:
- Heart rate >90 beats per minute
- Arterial hypotension (systolic BP <90 mmHg or decrease >40 mmHg)
- Mottled or discolored skin
- Decreased capillary refill
- Clammy/sweaty skin
Respiratory signs:
- Respiratory rate >20 breaths per minute
- Rapid breathing or breathlessness
- Difficulty breathing
- Arterial hypoxemia (SpO₂ ≤90%)
Neurological and Mental Status Changes
- Altered mental status
- Confusion
- Slurred speech
- Dizziness
- Sense of impending doom
Other Important Clinical Signs
- Decreased urine output (<0.5 ml/kg/h) or lack of urination in a day
- Severe muscle pain
- Nonblanching rash
- Gastrointestinal symptoms (including ileus, absent bowel sounds) 1, 3
Early Signs of Organ Dysfunction
Early recognition of organ dysfunction is critical as it indicates progression to severe sepsis:
- Respiratory dysfunction: SpO₂ ≤90%, central cyanosis, signs of respiratory distress
- Renal dysfunction: Acute oliguria, urine output ≤0.5 mL/kg/h
- Hepatic dysfunction: Jaundice
- Coagulation dysfunction: Petechiae, ecchymoses, bleeding from puncture sites
- Gastrointestinal dysfunction: Ileus, absent bowel sounds 1
Special Considerations for High-Risk Populations
- Immunocompromised patients, particularly those with neutropenia after chemotherapy, require special attention as they may not present with typical signs 1
- In neutropenic patients, white blood cell count cannot be used as a criterion to define sepsis, making other signs and symptoms even more important for early recognition
Clinical Pearls and Pitfalls
- Pitfall: Waiting for fever before considering sepsis. Many septic patients may be afebrile or hypothermic, especially elderly or immunocompromised patients.
- Pitfall: Focusing only on the primary site of infection while missing systemic signs. Research shows that systemic symptoms like altered mental status (OR=4.29), dyspnea (OR=2.92), gastrointestinal symptoms (OR=2.31), and muscle weakness (OR=2.24) strongly predict severe sepsis 3.
- Pearl: Temperature pattern changes, rather than absolute values, may provide earlier warning of developing sepsis 2.
- Pearl: The combination of multiple early warning signs significantly increases the likelihood of sepsis, even when individual signs might be attributed to other causes.
Early recognition and prompt intervention are critical, as timely administration of appropriate antibiotics and fluid resuscitation significantly improves outcomes 1, 4.