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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.