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. | – | – |