09 Dec

Sepsis and septic shock

Sepsis and septic shock

Definition of sepsis

Life-threatening organ dysfunction caused by a dysregulated host response to infection.

  • Describe the role of primary host response if in excess
  • Early recognition and treatment are important to reduce the mortality rate.
  • Non-specific SIRS criteria such as pyrexia and neutrophilia remain an important factor in the diagnosis of infections.

Clinical criteria to identify a septic patient

The current definition takes into account the host response towards any infection which leads to the typical four indicators namely fever, tachycardia, raise white cells and tachypnea. With this updated classification, these features alone do not indicate the presence of sepsis per the previous description.

However, these indicators remain useful in the identification of the presence of infection and invaluable in the clinical setting.

Based on the current definition, organ dysfunction is represented by an increase in the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score of 2 points or more. This scoring evaluates specific organs dysfunction which includes

  • Respiratory: PaO2/ FiO2 mmHg ratio
  • Coagulation: Platelets
  • Liver: Bilirubin level
  • CVS: MAP ≥ 70mmHg
  • CNS: Glasgow Coma Scale
  • Renal: Creatinine and Urine output

However, most of the parameters require specific tests and not routine in most centres. Hence, a screening tool is developed and validated for early recognition (qSOFA). This qSOFA include three major indicators of poor outcome and the need for further sepsis evaluation.

  • Systolic BP less than 100 mmHg
  • Altered mental status
  • Respiratory rate more than 22 breath per minute

Septic shock

Definition

A subset of sepsis with significant circulatory and cellular metabolism abnormalities leading to increased mortality.

Clinical criteria

Patients with septic shock can be identified by the presence of

  • Persistent hypotension requiring vasopressors to maintain MAP > 65mmHg
  • Serum lactate > 2 mmol/L (18 mg/L) despite adequate volume resuscitation

Patient in shock has an in-hospital mortality rate is in excess of 40%

These definitions do not change the management within the surviving sepsis campaign. However, these new terms enhance the early recognition and institutions of treatment and ultimately improved survival.

More info on this subject in Sepsis-3

 

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