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Table 1 Criteria proposed to define sepsis and severe sepsis; comparison of guidelines

From: Differences in reported sepsis incidence according to study design: a literature review

Sepsis definition Bone et al., 1992 (Sepsis-1) Levy et al., 2003 (Sepsis-2) Dellinger et al., 2013 Singer et al., 2016 (Sepsis-3)
  Infection, documented or suspected, and at least 2 of the following (SIRS criteria): Infection, documented or suspected, and some of the following: Suspected or documented infection and an acute increase of ≥2 SOFA points (a proxy for organ dysfunction)
General parameters Core temperature >38°C or <36°C >38.3°C or <36°C
Heart rate >90 bpm >90 bpm or >2 SD above the normal value for age
Tachypnea >20 breaths per minute or PaCO2 <32 mmHg No specification
Mental status Altered mental status Glasgow coma scale: SOFA score:
13-14 1
10-12 2
6-9 3
<6 4
Significant edema or positive fluid balance >20 mL/kg over 24 hrs
Hyperglycemia in the absence of diabetes Plasma glucose >120 mg/dL or >7.7 mM/L Plasma glucose >140 mg/dL or >7.7 mM/L
Inflammatory parameters White blood cell count >12,000/cu mm (leukocytosis) or <4,000/cu mm (leukopenia) or >10% immature (bands) forms >12,000/μL (leukocytosis) or <4,000/μL (leukopenia) or Normal white blood cell count with >10% immature forms
Plasma C reactive protein >2 SD above the normal value
Plasma procalcitonin >2 SD above the normal value
Hemodynamic parameters Arterial hypotension SBP <90 mmHg or MAP <70 or SBP decrease >40 mmHg in adults or <2 SD below normal for age MAP or administration of vasopressors (μg/kg/min): SOFA score:
MAP < 70 mm/Hg 1
dop ≤ 5 or dob (any dose) 2
dop > 5 or epi ≤ 0.1 or nor ≤ 0.1 3
dop > 15 or epi > 0.1 or nor > 0.1 4
Mixed venous oxygen saturation >70%
Cardiac index >3.5 L/min/m2
Organ dysfunction parameters Arterial hypoxemia PaO2/FIO2 <300 PaO2/FIO2: SOFA score:
<400 1
<300 2
<200 and mechanically ventilated 3
<100 and mechanically ventilated 4
Acute oliguria Urine output <0.5 mL/kg/hr or 45 mmol/L for at least 2 hrs Urine output <0.5 mL/kg/hr for at least 2 hrs despite adequate fluid resuscitation Creatinine (mg/dl) [μmol/L] (or urine output): SOFA score:
1.2–1.9 [110-170] 1
2.0–3.4 [171-299] 2
3.5–4.9 [300-440] (or < 500 mL/d) 3
> 5.0 [> 440] (or < 200 mL/d) 4
Creatinine increase >0.5 mg/dL >0.5 mg/dL or 44.2 μmol/L  
Coagulation abnormalities INR >1.5 or aPTT >60 s
Ileus Absent bowel sounds
Thrombocytopenia Platelet count <100 x 109/L Platelets x 103/μL: SOFA score:
< 150 1
< 100 2
< 50 3
< 20 4
Hyperbilirubinemia Plasma total bilirubin >4 mg/dL or 70 mmol/L Bilirubin (mg/dl) [μmol/L]: SOFA score:
1.2–1.9 [> 20-32] 1
2.0–5.9 [33-101] 2
6.0–11.9 [102-204] 3
> 12.0 [> 204] 4
Tissue perfusion parameters Hyperlactatemia >1 mmol/L
Capillary refill Decreased capillary refill or mottling
Severe sepsis definition Bone et al., 1992 Dellinger et al., 2013 Singer et al., 2016
  Sepsis associated with but not limited to Any of the below thought to be due to the infection
Hypo-perfusion   Hypotension (sepsis-induced), in the absence of other causes Systolic blood pressure < 90 mmHg or A reduction of ≥ 40 mmHg from baseline. As defined for sepsis
Lactate Lactic acidosis Lactate above upper limit of laboratory normal
Organ failure Kidney injury Oliguria As defined for sepsis but Creatinine > 2 mg/dL (176.8 μmol/L)
  Acute lung injury Pneumonia not the infectious source: PaO2/FIO2 < 250 or Pneumonia the infectious source: PaO2/FIO2 < 200
Liver injury As defined for sepsis but Bilirubin > 2 mg/dL (34.2 μmol/L)
Mental status Acute alteration As defined for sepsis
Septic shock Hypotension despite adequate fluid resuscitation along with the presence of perfusion abnormalities, as listed above. Hypotension not reversed with fluid resuscitation. Sepsis with persisting hypotension requiring vasopressors to maintain MAP ≥65 mmHg and having a serum lactate level >2 mmol/L (18mg/dL) despite adequate volume resuscitation.
Multiple organ dysfunction syndrome (MODS) Altered organ dysfunction in an acutely ill patient such that homeostasis cannot be maintained without intervention.