Sepsis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

Synonyms and keywords: sepsis syndrome; septic shock; septicemia

Overview

There are many complications associated with sepsis, especially because it is a systemic phenomenon. Sepsis is a severe condition, and the prognosis of the patient will depend greatly on the condition and overall health of the patient. Many factors, such as age, hosts immune response, site of infection, type of infection, appropriate antibiotic therapy, and restoration of circulation of perfusion contribute to the overall prognosis.

Natural History

Complications

Prognosis

Sepsis

SIRS criteria identify 88% of patients who have severe sepsis (infection plus organ failure).[1]

Septic shock

About 12% of of patients with sepsis progress to septic shock within 48 hours. Among variables studied (which did not include procalcitonin, predictors of progression to septic shock were:[2]

  • nonpersistent hypotension
  • bandemia at least 10%
  • lactate at least 4.0 mmol/L
  • past medical of coronary artery disease
  • female gender

Mortality

Mortality can be estimated with the MEDS (Mortality in Emergency Department Sepsis) score.[3][4]

Mortality in Emergency Department Sepsis)(MEDS) Point System[5]

The precise scoring system for the MEDS score is as follows:

  • Rapidly progressing terminal co-morbid illness - 6 points
  • If the patient is older than 65 years of age - 3 points
  • If the granulocytic bands are greater than 5% - 3 points
  • If the patient has tachypnea or hypoxia - 3 points
  • If the patient is in shock - 3 points
  • If the patient has a platelet count of less than 150,000 mm3 - 3 points
  • If the patient has an altered mental status - 2 points
  • If the patient is a resident of a nursing home - 2 points
  • If the patient has a lower respiratory infection - 2 points
Prognosis based on points[5]

The total score will be added up and that total will correlate to the mortality percentage with a 95% confidence interval. The following are the point ranges associated with various mortality percentages.

  • 0-4 points total - 0.6% mortality rate
  • 5-7 points total - 5% mortality rate
  • 8-12 points total - 19% mortality rate
  • 13-15 points total - 32% mortality rate
  • 15+ points total - 40% mortality rate

The area under the receiver operating characteristic curve for the MEDs score is 0.92.[3]

References

  1. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R (2015). "Systemic Inflammatory Response Syndrome Criteria in Defining Severe Sepsis". N Engl J Med. doi:10.1056/NEJMoa1415236. PMID 25776936.
  2. Capp R, Horton CL, Takhar SS, Ginde AA, Peak DA, Zane R; et al. (2015). "Predictors of Patients Who Present to the Emergency Department With Sepsis and Progress to Septic Shock Between 4 and 48 Hours of Emergency Department Arrival". Crit Care Med. doi:10.1097/CCM.0000000000000861. PMID 25668750.
  3. 3.0 3.1 Williams JM, Greenslade JH, Chu K, Brown AF, Lipman J (2016). "Severity Scores in Emergency Department Patients With Presumed Infection: A Prospective Validation Study". Crit Care Med. 44 (3): 539–47. doi:10.1097/CCM.0000000000001427. PMID 26901543.
  4. Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW (2003). "Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule". Crit. Care Med. 31 (3): 670–5. doi:10.1097/01.CCM.0000054867.01688.D1. PMID 12626967.
  5. 5.0 5.1 "Risk Stratifying the Potentially Septic Patient in the ED". Retrieved 2012-04-20.

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