Sepsis Diagnosis and Management

Diagnostic Criteria

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, with diagnosis based primarily on the Sequential Organ Failure Assessment (SOFA) score and clinical evidence of infection 1, 2
The American College of Critical Care Medicine defines sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection 3
Documented or suspected infection is a prerequisite for sepsis diagnosis 3

The National Early Warning Score 2 (NEWS2) is recommended for initial evaluation of sepsis risk 1, 2
NEWS2 interpretation for sepsis risk:
A score of 3 in any single parameter may indicate increased risk from sepsis 1
The SOFA score is the primary tool for diagnosing sepsis-related organ dysfunction, and includes assessment of respiratory, cardiovascular, hepatic, coagulation, renal, and neurological function 3, 4, 5

Common infection indicators include fever, hypothermia, leukocytosis, leukopenia, and elevated C-reactive protein or procalcitonin 3, 5, 6
Organ dysfunction markers include respiratory (PaO2/FiO2 <300, SpO2 ≤90%), cardiovascular (systolic BP <90 mmHg), renal (urine output <0.5 mL/kg/h), hepatic (hyperbilirubinemia), coagulation (thrombocytopenia), and neurological (altered mental status) 1, 3

Sepsis-Induced Coagulopathy (SIC) is a specific complication of sepsis affecting the coagulation system, with diagnostic criteria including platelet count, PT-INR, and SOFA score 4, 5, 7
Patients with SIC have higher mortality rates and may benefit from specific interventions 5

Patients should be re-evaluated based on risk stratification, with high-risk patients re-evaluated every 30 minutes, moderate-risk patients every hour, and low-risk patients every 4-6 hours 1, 5
Deterioration or lack of improvement should prompt re-evaluation of risk 1

The International Society on Thrombosis and Haemostasis (ISTH) recommends a two-step diagnostic approach for Sepsis-Associated Coagulopathy, starting with screening sepsis patients with thrombocytopenia using SIC diagnostic criteria, which includes platelet count, PT ratio, and SOFA score 8
SIC diagnostic criteria include platelet count, PT ratio, and SOFA score, with a total score ≥4 confirming SIC diagnosis, as recommended by the Journal of Thrombosis and Haemostasis 9
Patients with SIC have higher mortality rates and may benefit from specific interventions, according to the Journal of Thrombosis and Haemostasis 9, 10
ISTH overt DIC criteria include platelet count, fibrin-related markers, PT prolongation, and fibrinogen, with a total score ≥5 confirming overt DIC, as reported in the Journal of Thrombosis and Haemostasis 11, 9, 12

Mid-regional proadrenomedullin (MR-proADM) has shown utility in detecting multiple types of organ failure in sepsis, including respiratory, coagulation, cardiovascular, neurological, and renal, as reported in a study 11