How to identify SEPTIC patients

Consider using the quick SOFA (qSOFA) score in emergency department (ED) and non-ICU patients, if you think they have a serious infection....
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

There will be confusion about how to identify septic patients due to new Sepsis-3 criteria from the Society of Critical Care Medicine. For years, we've identified sepsis as suspected infection plus at least two systemic inflammatory response syndrome (SIRS) criteria; heart rate > 90, white blood cell count > 12,000/mm3 or < 4,000/mm3, etc. But SIRS criteria don't correlate well with poor outcomes.

The new thinking is that suspected infection PLUS organ dysfunction is a better way to predict sepsis mortality. We previously called this "severe sepsis." Expect to see more emphasis on confirming organ dysfunction before labeling your patient as septic...

  • IMPORTANT!
    Look for organ dysfunction to identify septic patients...

          You may hear you need a Sequential Organ Failure Assessment (SOFA) score to measure organ involvement especially in the ICU. But it's still okay to use traditional markers such as creatinine over 2 mg/dL or INR over 1.5. Consider using the quick SOFA (qSOFA) score in emergency department (ED) and non-ICU patients, if you think they have a serious infection. For qSOFA, check for systolic blood pressure ≤ 100 mmHg, altered mental status and respiratory rate ≥ 22 breaths/min. Consider ICU transfer if at least 2 of these are present, this may indicate higher risk of death.

Be aware that septic SHOCK criteria have also changed. You will now need to consider BOTH a lactate level > 2 mmol/L AND a vasopressor to keep mean arterial pressure ≥ 65 mmHg despite fluid resuscitation. Don't delay therapy, including antibiotics, in ANY patient suspected to have infection regardless of qSOFA or SOFA scores. Keep in mind, sepsis treatment hasn't changed. For now, continue to follow the Surviving Sepsis Campaign and Joint Commission's 3-hour bundle, lactate, broad-spectrum antibiotics, etc. Stay tuned for Joint Commission and Centers for Medicare & Medicaid Services (CMS) to weigh in. And look for updated Surviving Sepsis guidelines in late 2021.

note
For more details, see our notes on Sepsis protocol and antibiotic dosing in septic patients..

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