SIRS, Sepsis, and Septic Shock Criteria
Defines the severity of sepsis and septic shock.
- Note: sepsis definitions are evolving and difficult to finalize without a gold standard. These criteria are what is reported and the literature is listed, but note that nuances exist for all sepsis definitions and can differ locally, regionally, nationally, and internationally, as well as in clinical vs. administrative vs. research settings. Sepsis-3 Consensus Definitions are frequently cited as one paradigm.
- For patients under 18, please use the Pediatric SIRS, Sepsis, and Septic Shock Criteria.
Management
- When a patient presents with two or more SIRS criteria but with hemodynamic stability (i.e. blood pressure at baseline), a clinical assessment must be made to determine the possibility of an infectious etiology.
- If an infection is suspected or confirmed, the patient is diagnosed with sepsis and a lactate level is obtained to determine the degree of hypoperfusion and inflammation. A lactate level ≥2 mmol/L is considered elevated, and aggressive management with broad spectrum antibiotics, intravenous fluids, and vasopressors should be considered.
- Patients that present with a suspected or confirmed infection AND hemodynamic instability should immediately be treated for septic shock. While SIRS criteria will likely be present in these patients, aggressive management should not be delayed while waiting for laboratory values such as the WBC or lactate.
- Early recognition of sepsis, severe sepsis, and septic shock, and early administration of broad spectrum and organism specific antibiotic are the most critical actions.
- There remains controversy in the type of fluids that should be used, their quantity, and the timing of vasopressors and/or inotropes.
Critical Actions
- Assess all patients presenting with two or more SIRS criteria for the possibility of an infectious etiology.
- Screen for severe sepsis by obtaining a lactate level on patients with sepsis that are elderly, immunocompromised, or ill appearing.
- Some experts recommend obtaining a lactate level on all patients in whom blood cultures are sent. This is institution dependent however and not mandated in any guidelines.
- When severe sepsis or septic shock are identified, initiate broad spectrum antibiotics immediately. These antibiotics should be organism specific and therefore institutional antibiograms should be used.
- The Surviving Sepsis Campaign Guidelines recommend initiation of antimicrobials within one hour from the time of recognition of severe sepsis or septic shock, or within three hours of the patient’s arrival to the hospital.