Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to an infection. Sepsis is increasingly recognised as an important cause of mortality in the UK and there has been increasing efforts recently to improve the care of patients who present with sepsis.
How sepsis is classified has changed in recent years - the Surviving Sepsis Guidelines were updated in 2017.
The new guidelines recognise the following terms:
The old category of severe sepsis is no longer used.
The term 'systemic inflammatory response syndrome (SIRS)' has also fallen out of favour. Adult patients outside of ICU with suspected infection are identified as being at heightened risk of mortality if they have quickSOFA (qSOFA) score meeting >= 2 of the following criteria: respiratory rate of 22/min or greater, altered mentation, or systolic blood pressure of 100mmHg or less
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qSOFA score
Within an ICU setting a full SOFA^^ score is often used. Details can be found at the bottom of the notes.
NICE released its own guidelines in 2016. These focused on the risk stratification and management of patients with suspected.
For risk stratification NICE recommend using the following criteria:
| Red flag criteria | Amber flag criteria |
|---|---|
| • Responds only to voice or pain/ unresponsive | |
| • Acute confusional state | |
| • Systolic B.P <= 90 mmHg (or drop >40 from normal) | |
| • Heart rate > 130 per minute | |
| • Respiratory rate >= 25 per minute | |
| • Needs oxygen to keep SpO2 >=92% | |
| • Non-blanching rash, mottled/ ashen/ cyanotic | |
| • Not passed urine in last 18 h/ UO < 0.5 ml/kg/hr | |
| • Lactate >=2 mmol/l | |
| • Recent chemotherapy | - Relatives concerned about mental status |
Clearly, the underlying cause of the patient's sepsis needs to be identified and treated and the patient supported regardless of the cause or severity. If however any of the red flags are present the 'sepsis six' should be started straight away: