History and exam
Key diagnostic factors
common
tachycardia
Heart rate >90 bpm (>100 bpm in pregnant women).
tachypnea
Respiratory rate >20 breaths/minute.
high (>101°F [>38°C]) or low (<96.8°F [<36°C]) temperature
Temperature should not be used as the sole predictor of sepsis and should not be used to rule sepsis in or out.
Fever may not be apparent in the following groups of people with sepsis: older people or those who are very frail, people undergoing treatment for cancer, immunocompromised people, severely ill people with sepsis, and people with a spinal cord injury.[10]
Temperature rise can result from a physiologic response (e.g., after surgery or trauma).
Hypothermia is a common presenting sign and carries a worse prognosis.[71]
acutely altered mental status
Due to impaired cerebral perfusion and inflammatory cytokines.
poor capillary refill, mottling of the skin, or ashen appearance
Signs of circulatory insufficiency. [Figure caption and citation for the preceding image starts]: Capillary refill time. Top image: normal skin tone; middle image: pressure applied for 5 seconds; bottom image: time to hyperemia measuredFrom the collection of Ron Daniels, MB, ChB, FRCA; used with permission [Citation ends].
signs associated with specific source of infection
The source of infection may be immediately evident; for example, with classical signs and symptoms of pneumonia (purulent sputum, dyspnea, tachypnea, cyanosis) or an acute abdomen (abdominal pain, guarding, distension, tenderness, absent bowel sounds). However, in many patients the origin must be actively sought.
low oxygen saturation
Oxygen saturation <96% (or <88% for patients at risk of hypercapnic respiratory failure).
Sign of circulatory insufficiency.
arterial hypotension
Systolic BP <90 mmHg, mean arterial pressure <65 mmHg, or reduction in systolic BP >40 mmHg from baseline.
May be present when sepsis leads to organ dysfunction.
The use of vasopressor agents to correct hypotension does not exclude shock.
decreased urine output
Urine output <0.5 mL/kg/hour for at least 2 hours, or no urine passed in the last 18 hours.
May be present when sepsis leads to organ dysfunction.
cyanosis
Sign of circulatory insufficiency.
Other diagnostic factors
common
purpura fulminans
Sign of organ dysfunction. [Figure caption and citation for the preceding image starts]: Severe purpura fulminans, most commonly associated with pneumococcal septicemiaFrom the collection of Ron Daniels, MB, ChB, FRCA; used with permission [Citation ends].
uncommon
jaundice
Sign of organ dysfunction.
ileus
May be present when sepsis leads to organ dysfunction.
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