Diagnostic Criteria for Sepsis - Infection, documented or suspected, and some of the following:

• General variables
  • Fever (> 38.3°C); Hypothermia (core temperature < 36°C); Heart rate > 90/min or more than two sd above the normal value for age; Tachypnea; Altered mental status; Significant edema or positive fluid balance (> 20 mL/kg over 24 hr); Hyperglycemia (plasma glucose > 140 mg/dL or 7.7 mmol/L) in the absence of diabetes
• Inflammatory variables
  • Leukocytosis (WBC count > 12,000/μL); Leukopenia (WBC count > 4000/μL); Normal WBC count with greater than 10% immature forms; Plasma C-reactive protein more than two sd above the normal value; Plasma procalcitonin more than two sd above the normal value
• Hemodynamic variables
  • Arterial hypotension (SBP < 90 mm Hg, MAP < 70 mm Hg, or an SBP decrease > 40 mm Hg in adults or less than two sd below normal for age)
• Organ dysfunction variables: See severe sepsis definition
• Tissue perfusion variables
  • Hyperlactatemia (> 1 mmol/L); Decreased capillary refill or mottling

Severe Sepsis:

• Severe Sepsis is Sepsis and new onset of any 1 organ dysfunction:
  • Sepsis-induced hypotension
  • Lactate above upper limits laboratory normal
  • Urine output < 0.5 mL/kg/hr for more than 2 hrs despite adequate fluid resuscitation
  • Acute lung injury with PaO2/FIO2 < 250 in the absence of pneumonia as infection source
  • Acute lung injury with PaO2/FIO2 < 200 in the presence of pneumonia as infection source
  • Creatinine > 2.0 mg/dL (176.8μmol/L)
  • Bilirubin > 2 mg/dL (34.2μmol/L)
  • Platelet count < 100,000μL
  • Coagulopathy (international normalized ratio > 1.5)

Septic Shock:

• Septic Shock is Severe Sepsis with refractory hypotension
• SBP < 90, MAP < 65 or a decrease of > 40 points in SBP from baseline that does not resolve or reoccurs after a 30 ml/kg fluid bolus