Sepsis & Sepsis Six

Sepsis is the presence of infection resulting in systemic inflammatory response.
Infection and systemic inflammation results in organ dysfunction.

What are the factors which may make a patient prone to develop sepsis?

Whether a patient with infection will develop sepsis depends on a number of factors. These factors include:
1. Genetic predisposition to sepsis
2. Large microbiological load
3. Virulence of offending organism
4. Delay in source control
5. Antimicrobial resistance
6. Poor immune status/nutrition, frail patients

Definition of Sepsis

Quick SOFA (Sequential Organ Failure Assessment) score.

(From the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)

Patients with suspected infection who have two or more of:
1. Hypotension – systolic blood pressure < 100 mmHg
2. Altered mental status – Glasgow Coma Scale score ≤ 14
3. Tachypnoea – respiratory rate ≥ 22 breaths/min

Sepsis, once diagnosed, can be assessed in detail in ICU with Sequential Organ Failure Assessment (SOFA) score (See next flashcard)

SOFA Score

SOFA Score interpretation
– A score of 1–4 is allocated to six organ systems (respiratory, cardiovascular, liver, renal, coagulation and neurological) to represent the degree of organ dysfunction, e.g. platelet count >150×10 9 /L scores 1 point, <25×10 9 /L scores 4 points
– Composite score out of 24
– Higher scores are associated with increased mortality

Septic Shock

Septic shock is a subset of sepsis with underlying circulatory or cellular/metabolic abnormalities associated with a substantially increased mortality:
Sepsis and both of following (after fluid resuscitation):
1. Persistent hypotension requiring vasopressors to maintain a MAP > 65 mmHg
2. Serum lactate > 2 mmol/L (18 mg/dL)

Sepsis Six

What are the six things to do in first hour according to International recommendations for the immediate management of suspected sepsis from the Surviving Sepsis Campaign?

1. Deliver high-flow oxygen
2. Take blood cultures
3. Administer intravenous antibiotics
4. Measure serum lactate and send full blood count
5. Start intravenous fluid replacement
6. Commence accurate measurement of urine output