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Diagnostic Criteria for Sepsis

 

Infection,a documented or suspected, and some of the following:b

 

General variables

·        Fever (core temperature >38.3°C)

·        Hypothermia (core temperature <36°C)

·        Heart rate >90 /min or >2 SD above the normal value for age

·        Tachypnea

·        Altered mental status

·        Significant edema or positive fluid balance (>20 mL/kg over 24 hrs)

·        Hyperglycemia (plasma glucose >120 mg/dL or 7.7 mmol/L) in the absence of diabetes

Inflammatory variables

·        Leukocytosis (WBC count >12,000 /mm3)

·        Leukopenia (WBC count <4000 /mm3)

·        Normal WBC count with >10% immature forms

·        Plasma C-reactive protein >2 SD above the normal value

·        Plasma procalcitonin >2 SD above the normal value

Hemodynamic variables

·        Arterial hypotensionb (SBP <90 mm Hg, MAP <70, or an SBP decrease >40 mm Hg in adults or <2 SD below normal for age)

·        SvO2 >70%b

·        Cardiac index (CI) >3.5 L.min-1.M-23

Organ dysfunction variables

·        Arterial hypoxemia (PaO2/FIO2 <300)

·        Acute oliguria (urine output <0.5 mL.kg-1.hr-1 or 45 mmol/L for at least 2 hrs)

·        Creatinine increase >0.5 mg/dL

·        Coagulation abnormalities (INR >1.5 or aPTT >60 secs)

·        Ileus (absent bowel sounds)

·        Thrombocytopenia (platelet count <100,000 /mm3)

·        Hyperbilirubinemia (plasma total bilirubin >4 mg/dL or 70 mmol/L)

Tissue perfusion variables

·        Hyperlactatemia (>1 mmol/L)

·        Decreased capillary refill or mottling

 

WBC, white blood cell; SBP, systolic blood pressure; MAP, mean arterial blood pressure; SvO2, mixed venous oxygen saturation; INR, international normalized ratio; aPTT, activated partial thromboplastin time.

aInfection defined as a pathologic process induced by a microorganism;

bSvO2 sat >70% is normal in children (normally, 75–80%), and CI 3.5–5.5 is normal in children; therefore, NEITHER should be used as signs of sepsis in newborns or children;

cdiagnostic criteria for sepsis in the pediatric population are signs and symptoms of inflammation plus infection with hyper- or hypothermia (rectal temperature >38.5 or < 35°C), tachycardia (may be absent in hypothermic patients), and at least one of the following indications of altered organ function: altered mental status, hypoxemia, increased serum lactate level, or bounding pulses.

Related Criteria

Definitions for the Terms Bacteremia, Sepsis, Severe Sepsis, Septic Shock, and Other Related Disorders

Diagnostic Criteria for Disseminated Intravascular Coagulation (DIC)

Diagnostic Criteria for Adult Respiratory Distress Syndrome (ARDS)

More...

References:

  1. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003 Apr;31(4):1250-6. [Medline]

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Created: August 02, 2005
Last Modified: 10/24/2010

 
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