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 hypotension^b (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.

Created: August 02, 2005
Last Modified: 03/06/2006