Diagnostic criteria

International sepsis definitions [1]

1. Definitive diagnosis requires clinical identification of infection in a patient who also meets the clinical criteria for the Systemic Inflammatory Response Syndrome (SIRS). According to a revised consensus conference definition in 2001, SIRS is defined by the presence of 2 or more criteria from a collection of clinical signs and laboratory investigations as follows: [Surviving Sepsis Campaign: evaluation for severe sepsis screening tool] (external link) Temperature >38.3C (101F) or <36.0C (96.8F) Tachycardia >90 bpm Tachypnoea >20 breaths/minute PCO2 <4.3 kPa (32 mmHg) Hyperglycaemia (blood glucose >6.66 mmol/L [120 mg/dL]) in absence of diabetes mellitus Acutely altered mental status WBC count >1210^9/L (12,000/microlitre) or <410^9/L (4000/microlitre), or normal WBC count with >10% immature forms. 2. Sepsis: when SIRS is present in an individual patient and the cause is thought likely to be an infection, sepsis is present. 3. Severe sepsis: present when sepsis leads to dysfunction of 1 or more organ systems, and includes the subset septic shock. Organ dysfunction variables are: Arterial hypoxaemia (PaO2/FiO2 ratio <300) with new pulmonary infiltrates A new or increased oxygen requirement to maintain SpO2 >90% Acute oliguria (urine output <0.5 mL/kg/hour for at least 2 hours) Serum creatinine >176.8 micromol/L (2.0 mg/dL) Coagulation abnormalities (INR >1.5 or aPTT >60 seconds) Thrombocytopenia (platelets <100 10^9/L [100,000/microlitre]) Hyperbilirubinaemia (total bilirubin >68.42 micromol/L [4 mg/dL])

Arterial hypotension (systolic BP <90 mmHg, mean BP <65 mmHg, or reduction in systolic BP >40 mmHg from baseline) Serum lactate >2 mmol/L. 4. Septic shock is defined as: Arterial hypotension (systolic BP <90 mmHg, mean BP <65 mmHg, or reduction in systolic BP >40 mmHg from baseline) persisting for at least 1 hour, despite adequate fluid resuscitation, or Serum lactate >4 mmol/L after adequate fluid resuscitation. The use of vasopressor agents to correct hypotension does not exclude shock.

Acute physiology and chronic health evaluation II score (APACHE II) [72]
The APACHE score is commonly used to establish illness severity in the ICU and predict the risk of death. [APACHE II calculator] (external link) There is a high risk of death if the score is 25. There are several other models that have been developed for use in the ICU, including APACHE III, Mortality in Emergency Department Sepsis score, Simplified Acute Physiology Score, Sepsis-related Organ Failure Assessment, and Mortality Probability Model II. [28] [73] [74]