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SIRS vs SEPSIS

OVERVIEW

The original definitions of sepsis and related conditions (SIRS, severe sepsis and
septic shock) are now more than 20 years old (Sepsis- 1 originated from the
ACCP/SCCM consensus meeting in 1991 and Sepsis 2 from 2001)

SEPSIS 3 DEFINITIONS

Sepsis is life-threatening organ dysfunction due to a dysregulated host response to


infection

Sepsis clinical criteria: organ dysfunction is defined as an increase of 2


points or more in the Sequential Organ Failure Assessment (SOFA)
score

o for patients with infections, an increase of 2 SOFA points gives an


overall mortality rate of 10%

Patients with suspected infection who are likely to have a prolonged


ICU stay or to die in the hospital can be promptly identified at the
bedside with qSOFA (HAT); i.e. 2 or more of:

o Hypotension: SBP less than or equal to 100 mmHg

o Altered mental status (any GCS less than 15)

o Tachypnoea: RR greater than or equal to 22

Septic shock is a subset of sepsis in which underlying circulatory and


cellular/metabolic abnormalities are profound enough to substantially increase
mortality.

Septic shock clinical criteria: Sepsis and (despite adequate volume


resuscitation) both of:

o Persistent hypotension requiring vasopressors to maintain


MAP greater than or equal to 65 mm Hg, and

o Lactate greater than or equal to 2 mmol/L

With these criteria, hospital mortality is in excess of 40%

Not that the term severe sepsis is no longer in use.


PREVIOUS SURVIVING SEPSIS CAMPAIGN DEFINITION

Systemic inflammatory response syndrome (SIRS) requires 2 or more of the


following (the definition differs for children):

1. T >38 C or <36 C
2. P >90/min
3. RR >20/min or PaCO2 <32 mmHg
4. WCC >12 or >10% immature band forms

Sepsis

Sepsis is SIRS + confirmed or presumed infections

mortality: 10-15%

Severe Sepsis

Severe Sepsis is sepsis with organ dysfunction

organ dysfunction includes:

o SBP <90 mmHg or MAP < 65 mmHg or lactate > 2.0 mmol/L (after
initial fluid challenge)

o INR >1.5 or a PTT >60 s

o Bilirubin >34 mol/L

o Urine output <0.5 mL/kg/h for 2 h

o Creatinine >177 mol/L

o Platelets <100 109/L

o SpO2 <90% on room air


mortality: 17-20%

Septic Shock

Septic shock is defined as sepsis with refractory hypotension

o hypotension is defined as SBP <90 mmHg or MAP <70 mmHg

o refractory means that hypotension persists after 30 mL/kg crystalloid;


i.e. vasopressor dependence after adequate volume resuscitation

mortality: 43-54%

APACHE and SOFA are scoring systems that are commonly used in intensive care
APACHE = Acute Physiology, Age and Chronic Health Evaluation (I-IV)
SOFA = Sequential Organ Failure Assessment

APACHE VERSUS SOFA

Feature APACHE SOFA


Three factors that
influence outcome in
critically ill patients Degree of organ dysfunction is related to acute
1. chronic background illness(initially based on sepsis related organ
Basis
disease dysfunction but later validated for organ
2. patient reserve dysfunction not related to sepsis)
3. severity of acute
illness
Score Physiological variable, Defined score (1-4) for each of six organ systems
chronic health conditions, 1. respiratory
emergency / elective 2. CVS
admissions, and 3. CNS
post-operative / non- 4. renal
operative admissions 5. coagulation and
6. liver
Based on the most
Scoring abnormal measurements daily scoring of individual and composite scores
duration in the first 24 hours of possible during course of ICU stay
ICU stay
Population Standardised mortality No predicted mortality algorithm.
outcome ratios can be used for In general, higher SOFA score is associated with
comparison large patient populations worse outcome.Treatment effects on SOFA
Not possible to predict
Individual
individual patient response of organ dysfunction to therapy can be
patient
outcome or response to followed over time
outcomes
therapy

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