Definitions Sepsis is the precipitating condition to septic shock, hence the diagnostic criteria for sepsis are pertinent to the diagnosis of septic shock. There are three different systems to diagnosis sepsis. The most recent gathering of professionals to discuss the topic of sepsis was called "sepsis-3" and set forth the latest guidelines for the diagnosis and management of sepsis.
SIRS The SIRS criteria were recently excluded from sepsis-3, but are still the most used diagnostic tool for identifying sepsis. A patient that meets SIRS criteria has a possible, or documented, source of infection plus at least two or more of the criteria listed below. •
Tachypnea (fast rate of breathing), which is defined as more than 20 breaths per minute, or when testing
blood gas, a PaCO2| less than 32 mm Hg, which signifies hyperventilation •
White blood cell count either significantly low (3), or elevated (> 12000 cells/mm3) •
Tachycardia (rapid
heart rate), which in sepsis is defined as a rate greater than 90 beats per minute • Altered body
temperature:
Fever > or hypothermia < Documented evidence of infection may include positive
blood culture, signs of pneumonia on chest x-ray, or other radiologic or laboratory evidence of infection. Signs of
end-organ dysfunction are present in septic shock, including
kidney failure, liver dysfunction, changes in mental status, or elevated serum
lactate. One limitation of the SIRS criteria is that it can be present in many non-infectious conditions, such as autoimmune conditions, pancreatitis, recent surgery, or vasculitis.
qSOFA and SOFA qSOFA is another set of criteria used to diagnose sepsis and help clinicians identify sepsis in settings other than the ICU. SOFA criteria is used in critically ill patients and assesses the severity of dysfunction in the 6 organ systems. At the time of ICU admission the score is calculated as the baseline. After this the score is calculated every 48 hours. Septic shock refers specifically to distributive shock due to
sepsis as a result of infection. However, in recent years, it has been found that hypotension is a later manifestation of septic shock. Specifically, lack of blood flow to the tissue (tissue hypoperfusion) has been found to occur well before hypotension in cases of septic shock. Therefore, a lactate measurement has become an integral part to the diagnosis of septic shock. A lactate level of 18 mg/dL (or 2 mmol per L) is diagnostic for septic shock according to sepsis-3. In particular, fever can be absent in immunocompromised patients, older patients, and patients with chronic alcohol abuse.
Musculoskeletal Joint pains, mylagias, edema, weakness, and crepitus.
Genitourinary Dysuria, hematuria, frequency, costovertebral angle tenderness, pyuria, vaginal bleeding, and vaginal discharge.
Dermatologic Petechiae, bullous lesions, erythema, rash, splinter hemorrhages, bruising, and purulent lesions.
Diagnostic tools Imaging Chest X-rays are typically indicated for every case of sepsis as pneumonia is the most common cause of sepsis. CT scans of the chest can also be used when empyema or infectious effusions are suspected. CT scans of other areas of the body can be used if abscesses are suspected.
Laboratory testing A large amount of laboratory tests are indicated when sepsis is suspected. In terms of cultures, typically clinicians order two sets of peripheral blood cultures, urine cultures, stool cultures, sputum, and skin cultures.
Sepsis biomarkers The two main biomarkers used for sepsis and septic shock are lactate and procalcitonin. A procalcitonin level of 0.05 ng/mL is considered normal and patients with procalcitonin levels less than 0.25 ng/mL have low likelihood of sepsis. Several studies have shown that the severity of sepsis and the procalcitonin levels have a statistically significant relationship. ==Treatment==