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Sepsis sepsis

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Surviving Sepsis Campaign 2021 guidelines sepsis septic shock official

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sepsis AND management

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Sepsis is a life-threatening organ dysfunction caused by the body’s uncontrolled response to an infection. It can progress quickly to septic shock, with dangerously low blood pressure and failure of organs such as the kidneys, lungs, brain, or heart.
Seek emergency care immediately if someone with suspected infection has:
  • Confusion, extreme sleepiness, or difficulty waking
  • Fast or difficult breathing
  • Blue, grey, mottled, or unusually cold skin
  • Very low urine output
  • Severe weakness, dizziness, fainting, or low blood pressure
  • Persistent fever or abnormally low temperature
Hospital treatment is time-sensitive: clinicians obtain cultures when feasible, give prompt broad-spectrum IV antibiotics, IV crystalloid fluids for poor perfusion, monitor lactate and organ function, control the infection source, and use vasopressors such as norepinephrine if blood pressure remains low. The Surviving Sepsis Campaign guidance recommends immediate antimicrobials for septic shock or high-likelihood sepsis and an initial 30 mL/kg crystalloid dose within 3 hours for sepsis-induced hypoperfusion or shock.
Septic shock is sepsis with persistent hypotension requiring vasopressors to keep mean arterial pressure at least 65 mmHg, plus lactate above 2 mmol/L despite adequate fluids.
If this concerns a real person who is currently unwell, call local emergency services or go to an emergency department now.

How to diagnose spesis

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Sepsis-3 definition SOFA qSOFA diagnostic criteria official 2026

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sepsis AND diagnosis

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How sepsis is diagnosed

Sepsis is a clinical diagnosis, not a single blood test. A clinician suspects or confirms an infection, then looks for new organ dysfunction caused by it.

1. Suspect an infection

Common sources include the lungs, urinary tract, abdomen, skin/wounds, bloodstream, or medical devices.
Possible signs:
  • Fever or unusually low temperature
  • Fast heart rate or breathing
  • Cough, painful urination, abdominal pain, infected wound, or diarrhea
  • Weakness, chills, confusion, or reduced urine output

2. Screen urgently for high-risk features

A quick bedside screen is qSOFA. In an adult with suspected infection, any 2 or more of these is a danger signal that needs urgent assessment:
  • Respiratory rate 22/min or more
  • Systolic blood pressure 100 mmHg or less
  • New altered mental state, such as confusion or drowsiness
qSOFA is a warning screen, not a test that confirms or rules out sepsis. The SCCM sepsis definitions advise that a positive qSOFA should prompt assessment for organ failure and urgent treatment.

3. Confirm organ dysfunction

The current Sepsis-3 clinical definition is:
Suspected or confirmed infection plus an acute increase in SOFA score of 2 or more points.
SOFA assesses six organ systems:
  • Lungs: low oxygen levels or need for respiratory support
  • Clotting: low platelet count
  • Liver: elevated bilirubin
  • Circulation: low blood pressure or need for vasopressors
  • Brain: altered consciousness, using Glasgow Coma Scale
  • Kidneys: increased creatinine or low urine output

4. Tests used to identify infection and severity

Typical urgent evaluation includes:
  • Vital signs, oxygen saturation, mental status, and urine output
  • CBC with differential, kidney function/electrolytes, liver tests, clotting tests
  • Serum lactate, which can indicate impaired tissue perfusion
  • Blood cultures, usually before antibiotics if this does not delay treatment
  • Urine, sputum, wound, or other site-specific cultures
  • Chest X-ray, ultrasound, or CT when needed to locate the infection source
No test, including white-cell count, CRP, procalcitonin, or lactate, can diagnose sepsis alone. They support the overall clinical assessment and help monitor severity. Harrison’s notes that diagnosis combines clinical findings with laboratory, imaging, and microbiology results, while actively considering non-infectious conditions that can mimic sepsis. Harrison’s Principles of Internal Medicine, 22e, p. 2363.

Septic shock

Septic shock is a more severe subset of sepsis. In Sepsis-3, it means:
  • Ongoing low blood pressure requiring a vasopressor to maintain mean arterial pressure at least 65 mmHg, and
  • Lactate over 2 mmol/L, despite adequate IV fluids.

Get emergency help now

Go to an emergency department or call emergency services if a person with a possible infection develops confusion, rapid or difficult breathing, fainting/dizziness, blue or mottled skin, very little urine, severe weakness, or low blood pressure. Do not wait for a lab test to be done at home.
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