Criteria

There are multiple scoring systems and definitions for sepsis and sepsis with organ dysfunction. None is perfect and many seek to measure similar variables. The Sequential (or Sepsis-related) Organ Failure Assessment (SOFA) score is recommended in the 2016 international consensus definitions but it is important to recognize that the clinical utility of any score relies on individual practitioner clinical assessment and decision-making. The SOFA criteria, and the systemic inflammatory response syndrome (SIRS) criteria that they replaced, both require laboratory analysis of blood tests. This can lead to delays in recognizing patients at risk of deterioration and organ dysfunction due to sepsis.

Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) (2016)[1]

1. Sepsis: the third international consensus definition published in 2016 redefines sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection. According to the 2016 consensus definitions, an increase in SOFA score of 2 or more constitutes organ dysfunction. The SOFA score is calculated based on the assessment of the following systems in the intensive care setting (ICU) setting: [ Sequential Organ Failure Assessment: SOFA Score Opens in new window ]

  • Respiratory (PaO₂/FiO₂ ratio)

  • Neurologic (as assessed by the Glasgow Coma Scale)

  • Cardiovascular (mean arterial pressure [MAP] or administration of vasopressors)

  • Coagulation (platelet count)

  • Renal (creatinine level and urine output)

  • Hepatic (bilirubin level).

The 2016 consensus definitions recommend that the SOFA criteria should replace the previously recommended set of criteria defining organ dysfunction, which had been proposed by the 2001 Consensus Definitions Conference. The "quick" (q)SOFA criteria were recommended for use outside of the ICU setting to promptly identify patients with suspected infection who are likely to have a poor outcome. However, the Surviving Sepsis Campaign strongly advises against using qSOFA as a single screening tool for sepsis or septic shock, due to its poor sensitivity for patients with suspected infection (compared with other bedside early warning scores and the SIRS criteria).[3][5][6]

2. Severe sepsis: in light of the revisions to the definition of sepsis, the 2016 consensus definitions recommend that the term "severe sepsis" (as defined in the 1991/2001 consensus definitions) should be made redundant.

3. Septic shock: the definition of septic shock has been redefined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.[1] According to the 2016 consensus definitions, septic shock is defined as sepsis with both:

  • Persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg, and

  • Serum lactate level >2 mmol/L (>18 mg/dL) despite adequate volume resuscitation.

Acute Physiology and Chronic Health Evaluation II score (APACHE II)[117]

The APACHE score is commonly used to establish illness severity in the ICU and predict the risk of death. [ APACHE II scoring system Opens in new window ] ​​​​​​​​​​ There is a high risk of death if the score is ≥25.

Other sepsis risk-scoring models

Several other models have been developed for use in the ICU, including APACHE III, the Simplified Acute Physiology Score, and the Mortality Probability Model II.[39][118][119]

Patient group-specific scoring systems have also been developed. For example, the Predisposition Insult Response and Organ failure and the Mortality in Emergency Department Sepsis scores have been developed to risk-stratify patients with sepsis or septic shock who are admitted to the emergency department; the Sepsis in Obstetrics Score has been developed to risk-stratify pregnant or postpartum women with sepsis.[120][121] These scoring systems can assist in the identification and management of sepsis in specific patient groups.[122]

There are numerous ongoing studies investigating techniques for "staging" the severity of sepsis using a variety of blood-borne markers.[95][123] Although some techniques have shown initial promise, the evidence base remains weak, and they have an unclear role in future clinical practice.

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