Sepsis Update 2

2. Sepsis Series: New Diagnostic Criteria for Sepsis

The traditional definition of Sepsis has been established in 1992 consensus statement by the American College of Chest Physicians and Society of Critical Care Medicine [Crit Care Med 1992;20:864–74.]. There is a strong likelyhood that sepsis may have been frequently missed [Crit Care 2004;8:R409–13.] using the 1992 consensus, and so in 2001, International Sepsis Definitions Conference refined previous definitions as:

Sepsis: documented or suspected infection, plus some of the following:

General Variables:

• Temp >38.3°C or <36°c
• HR >90 or >2 SD above normal value for age
• Tachypnea
• Hyperglycemia >120 mg/dL (6.6 mmol/L) with no history of DM
• Altered Mental Status
• Significant edema or positive fluid balance (>20 mL/kg over 24 h)

Inflammatory Variables:

• Leukocytosis (>12k) or Leukopenia (below 4k)
  
• Normal WBC with >10% immature forms
• Plasma C-RP >2 SD above the normal value
• Plasma calcitonin >2 SD above the normal value

Hemodynamic Variables:

• Arterial Hypotension: (SBP below 90, MAP below 70, more than 40 decrease on SBP baseline -- for adults or below 2 SD below normal for age)
  
• ScvO2 >70%
• Cardiac index >3.5 L/min/m²

Organ Dysfunction Variables:

• Arterial hypoxemia (PaO2/FiO2 <300)
• Acute olyguria (UOP below 0.5 mL/kg/h for at least 2 hours)
  
• Creatinine increase (>0.5 mg/dL)
• Coagulation abnormalities (INR >1.5 or aPTT >60sec)
• Ileus
• Thrombocytopenia (below 100k)
  
• Hyperbilirubinemia (plasma total bilirubin >4 mg/dL)

Tissue Perfusion Variables:

• Elevated lactate (>2 mmol/L)
• Decreased capillary refill (>2 sec or mottling)

Sepsis Series: Next Post, Sepsis Update 3, EGDT.
--
Data from [Crit Care Med 2003;31:1250-6]