From the Guidelines
Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.
Criteria for Sepsis
The criteria for sepsis include:
- Organ dysfunction: represented by an increase in the Sequential (sepsis-related) Organ Failure Assessment (SOFA) score of 2 points or more 1
- Dysregulated host response to infection: characterized by a systemic inflammatory response to infection, which can lead to organ dysfunction 1
- Quick SOFA (qSOFA) score: a score of 2 or more points, with points assigned for:
- Respiratory rate > 22/min
- Altered mentation
- Systolic blood pressure ≤ 100 mmHg 1
Importance of Early Recognition
Early recognition of sepsis is crucial, as it allows for prompt treatment and improves outcomes 1. The use of simple diagnostic criteria, such as qSOFA, can help identify patients who require critical care, especially in low-resource settings 1.
Clinical Application
In clinical practice, the diagnosis of sepsis should be based on a combination of clinical judgment, laboratory results, and imaging studies 1. The presence of organ dysfunction, as indicated by an increased SOFA score, is a key factor in the diagnosis of sepsis 1.
From the Research
Criteria for Sepsis
The criteria for sepsis have been defined by several studies, including the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) 2. According to this definition, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. The criteria for sepsis include:
- Life-threatening organ dysfunction, which can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more 2
- A quickSOFA (qSOFA) score of 2 or more, which includes respiratory rate, altered mentation, and systolic blood pressure 2, 3
- Serum lactate levels greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia 2
Septic Shock
Septic shock is 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 2. The criteria for septic shock include:
- Vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater
- Serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia 2
Limitations of Previous Definitions
Previous definitions of sepsis, such as the systemic inflammatory response syndrome (SIRS) criteria, have been shown to have limitations, including a lack of specificity and sensitivity 4, 2, 5. The new definition of sepsis, Sepsis-3, aims to address these limitations and provide a more accurate and consistent definition of sepsis 2, 6.
Clinical Criteria for Sepsis
Clinical criteria for sepsis have been evaluated in several studies, including the Assessment of Clinical Criteria for Sepsis study 3. This study found that the qSOFA score had predictive validity for in-hospital mortality among non-ICU encounters with suspected infection, and that the SOFA score had predictive validity for in-hospital mortality among ICU encounters with suspected infection 3.
Pediatric Sepsis
Pediatric sepsis has been defined by the Phoenix criteria, which include a Phoenix Sepsis Score of at least 2 points in children with suspected infection 5. However, these criteria have been shown to have limitations, including the exclusion of important criteria such as renal and liver dysfunction 5.