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Surviving Sepsis Guidelines' Criteria for Sepsis Diagnosis
PulmCCM is not affiliated with the Surviving Sepsis Guidelines or the Surviving Sepsis Campaign which is at http://www.survivingsepsis.org.
According to the Surviving Sepsis Guidelines, a sepsis diagnosis requires the presence of infection, which can be proven or suspected, and 2 or more of the following criteria:
- Hypotension (systolic blood pressure < 90 mm Hg or fallen by >40 from baseline, mean arterial pressure < 70 mm Hg)
- Lactate > 1 mmol/L
- Mottled skin
- Decreased capillary refill of nail beds or skin
- Fever > 38.3 degrees C, or 101 degrees F
- Hypothermia < 36 degrees C core temperature (<96.8 degrees F)
- Heart rate > 90
- Change in mental status
- Significant edema or positive fluid balance (>20 mL/kg over 24 hours)
- Hyperglycemia (>140 mg/dL) in someone without diabetes
- White blood cell count > 12,000 or less than 4,000, or with >10% "bands" (immature forms)
- Elevated C-reactive protein in serum (according to your lab's cutoffs)
- Elevated procalcitonin in serum (according to your lab)
- Arterial hypoxemia (paO2 / FiO2 < 300)
- Acute drop in urine output (<0.5 ml/kg/hr for at least 2 hours despite fluid resuscitation, or about 35 ml/hour for a 70 kg person)
- Creatinine increase > 0.5 mg/dL
- INR > 1.5 or aPTT > 60 seconds
- Absent bowel sounds (ileus)
- Platelet count < 100,000
- High bilirubin (total bilirubin > 4 mg/dL
The definition of severe sepsis is sepsis with impaired blood flow to body tissues (hypoperfusion) or detectable organ dysfunction. Severe sepsis may occur with or without sepsis-induced hypotension (e.g., with fever, encephalopathy and renal failure but a normal blood pressure).
The definition of septic shock is severe sepsis with sepsis-induced hypotension [systolic blood pressure < 90 mm Hg (or a drop of > 40 mm Hg from baseline) or mean arterial pressure < 70 mm Hg] that persists after adequate fluid resuscitation. "Adequate" is determined by the estimation of the patient's pre-sepsis intravascular volume status.