What is the diagnosis and management for a patient with suspected sepsis (Systemic Inflammatory Response Syndrome)?

From the Guidelines

A full sepsis workup should be initiated immediately in patients with suspected sepsis or septic shock, with the goal of identifying and treating the underlying infection and supporting organ function. This approach is based on the strongest and most recent evidence, including the 2016 Surviving Sepsis Campaign guidelines 1. The workup should include:

• Obtaining vital signs (temperature, heart rate, blood pressure, respiratory rate, oxygen saturation) and assessing mental status
• Laboratory tests, such as:
  • Complete blood count with differential
  • Comprehensive metabolic panel
  • Lactate level
  • Coagulation studies (PT/INR, PTT)
  • C-reactive protein or procalcitonin
• Blood cultures (two sets from different sites) should be drawn before starting antibiotics, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1
• Additional cultures from potential infection sources (urine, sputum, wound, cerebrospinal fluid) should be collected as clinically indicated
• Imaging studies, such as chest X-ray, and depending on suspected source, CT scans of relevant body regions
• Empiric broad-spectrum antibiotics should be administered within one hour of recognition, typically including coverage for both gram-positive and gram-negative organisms, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1
• Fluid resuscitation with crystalloids (30 ml/kg) should be initiated for hypotension or elevated lactate, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1
• Vasopressors (typically norepinephrine starting at 0.05 mcg/kg/min) may be needed if hypotension persists despite fluids, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1 and the World Journal of Emergency Surgery 1. The initial target mean arterial pressure should be 65 mmHg in patients with septic shock requiring vasopressors, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1. Resuscitation should be guided by frequent reassessment of hemodynamic status, including a thorough clinical examination and evaluation of available physiologic variables, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1. Dynamic over static variables should be used to predict fluid responsiveness, where available, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1. Lactate levels should be monitored and used to guide resuscitation, with the goal of normalizing lactate levels, as recommended by the 2016 Surviving Sepsis Campaign guidelines 1.

This aggressive approach is necessary because sepsis represents a medical emergency with high mortality rates, and early intervention significantly improves outcomes by controlling infection and supporting organ function before irreversible damage occurs.

From the Research

Full Sepsis Workup

• A full sepsis workup typically involves a combination of laboratory tests, imaging studies, and physical examinations to diagnose and manage sepsis [(2,3,4,5,6)].
• The workup may include:
  • Complete Blood Count (CBC) to guide clinicians in early-identifying patients at high risk of developing sepsis and to predict adverse outcomes 2.
  • Measurement of serum lactate levels, which have important prognostic value and can help define the patient's trajectory [(3,4,5)].
  • Imaging studies, such as chest X-rays or CT scans, to identify the source of infection 6.
  • Cultures, such as blood or urine cultures, to identify the causative organism 6.
  • Sepsis biomarkers, such as procalcitonin, to aid in diagnosis 6.
• The Sequential Organ Failure Assessment (SOFA) score is also an important tool for early diagnosis and management of sepsis 6.

Laboratory Tests

• CBC parameters, such as white blood cell count and platelet count, can be useful in diagnosing and managing sepsis 2.
• Lactate levels can be used to evaluate the severity of sepsis and guide resuscitation efforts [(3,4,5)].
• Other laboratory tests, such as blood urea nitrogen and creatinine, may also be useful in evaluating organ function and guiding management 6.

Imaging Studies

• Imaging studies, such as chest X-rays or CT scans, can help identify the source of infection and guide management 6.
• Other imaging studies, such as ultrasound or MRI, may also be useful in certain cases 6.

Management

• Fluid resuscitation is a priority in early management, with a goal of administering 30 mL per kg of intravenous crystalloid within the first three hours 6.
• Antimicrobial therapy should be initiated early, with a goal of starting within one hour of presentation 6.
• Vasopressor therapy may be indicated if hypotension persists despite fluid administration 6.