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Definition
Sepsis is a systemic, deleterious host response to infection, manifested as multi system organ dysfunction plus hypotension, that is not readily reversible with fluid resuscitation.
Diagnostic Criteria For Sepsis (Documented/Suspected Infection Plus Inflammatory variablesPlus One of The Organ Dysfunction)
- General variables
- Fever > 38.3°C
- Hypothermia ( core temperature < 36°C )
- Heart rate > 90/min–1 or > 2 SD above the normal value for age
- Tachypnea
- Altered mental status
- Edema
- Positive fluid balance ( > 20 mL/kg over 24 hr)
- Hyperglycemia ( plasma glucose > 140 mg/dL or 7.7 mmol/L ) in the absence of diabetes
- Inflammatory variables
- Leukocytosis ( WBC count > 12,000 µL–1 )
- Leukopenia ( WBC count < 4000 µL–1 )
- Immature WBCs forms are > 10% with normal count
- Plasma C-reactive protein > 2 SD above the normal value
- Plasma procalcitonin > 2 SD above the normal value
- Hemodynamic variables
- Arterial hypotension after 30 ml/kg fluid bolus ( SBP < 90 mm Hg, MAP < 70 mm Hg, or an SBP decrease > 40 mm Hg in adults or < 2 SD below normal for age )
- Organ dysfunction variables
- Arterial hypoxemia ( Pao2/Fio2 < 300 )
- Acute oliguria ( urine output < 0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation )
- Creatinine increase > 0.5 mg/dL or 44.2 µmol/L
- Coagulation abnormalities ( INR > 1.5 or aPTT > 60 Sec )
- Ileus ( absent bowel sounds )
- Thrombocytopenia ( platelet count < 100,000 µL–1 )
- Hyperbilirubinemia ( plasma total bilirubin > 4 mg/dL or 70 µmol/L )
- Tissue perfusion variables
- Hyperlactatemia > 1 mmol/L
- Decreased capillary refill or mottling