From the Guidelines
A sepsis workup should include a comprehensive medical evaluation with blood tests, such as complete blood count, comprehensive metabolic panel, lactate levels, and blood cultures, as well as urinalysis, chest X-ray, and other imaging studies to locate the source of infection. This is based on the Surviving Sepsis Campaign guidelines, which emphasize the importance of early identification and appropriate management of sepsis to improve outcomes 1. The workup should be performed urgently, as sepsis can progress rapidly and mortality increases significantly with each hour of delayed treatment.
Key Components of a Sepsis Workup
- Blood tests: complete blood count, comprehensive metabolic panel, lactate levels, and blood cultures to identify the causative organism
- Urinalysis to check for urinary tract infection
- Chest X-ray to check for pneumonia or other respiratory infections
- Other imaging studies, such as CT scans or ultrasounds, to locate the source of infection
- Vital signs monitoring, including temperature, heart rate, blood pressure, and respiratory rate
Treatment
Once sepsis is suspected, treatment should begin immediately with broad-spectrum antibiotics, such as vancomycin and piperacillin-tazobactam, or meropenem, adjusted based on the patient's kidney function 1. Fluid resuscitation with crystalloids should be administered to maintain blood pressure, and vasopressors may be needed if hypotension persists. The goal of treatment is to identify and treat the infection quickly while supporting failing organ systems to prevent progression to septic shock and death.
Importance of Early Intervention
Early identification and treatment of sepsis are critical to improving outcomes, as mortality increases significantly with each hour of delayed treatment 1. Therefore, a sepsis workup should be performed urgently, and treatment should begin immediately if sepsis is suspected.
From the Research
Sepsis Workup Overview
- A sepsis workup typically involves a combination of laboratory tests, imaging studies, and physical examinations to diagnose and manage sepsis.
- The goal of a sepsis workup is to rapidly identify patients at high risk of developing sepsis and to predict adverse outcomes 2.
Laboratory Tests
- Complete Blood Count (CBC) is a valuable test in the diagnosis and prognosis of sepsis, providing information on individual health status 2, 3.
- CBC parameters, such as white blood cell count, neutrophil to lymphocyte ratio (NLR), and fraction of immune granulocytes, can help identify patients at risk of sepsis 3.
- Serum lactate measurement is also an important tool in the diagnosis of septic shock 4.
- Procalcitonin and lactate levels are used as sepsis biomarkers to aid in diagnosis and management 4.
Imaging Studies and Cultures
- Imaging studies, such as chest X-rays or CT scans, may be ordered to identify the source of infection 4.
- Cultures, including blood, urine, and respiratory cultures, are obtained to identify the causative organism and guide antimicrobial therapy 4.
Clinical Evaluation
- Initial evaluation of patients with suspected sepsis includes basic laboratory tests, cultures, imaging studies as indicated, and sepsis biomarkers 4.
- The Sequential Organ Failure Assessment (SOFA) score is used to assess organ dysfunction and predict mortality 4.
- Physical examination and medical history are also crucial in diagnosing and managing sepsis, particularly in older patients and those who are immunocompromised 4.