a wound culture – where a small sample of tissue, skin or fluid is taken from the affected area for testing. respiratory secretion testing – taking a sample of saliva, phlegm or mucus. blood pressure tests. imaging studies – like an X-ray, ultrasound scan or computerised tomography (CT) scan.
There is no definitive diagnostic test for sepsis. Along with clinical data, laboratory testing can provide clues that indicate the presence of or risk of developing sepsis. Serum lactate measurement may help to determine the severity of sepsis and is used to monitor therapeutic response.
Four SIRS criteria were defined, namely tachycardia (heart rate >90 beats/min), tachypnea (respiratory rate >20 breaths/min), fever or hypothermia (temperature >38 or <36 °C), and leukocytosis, leukopenia, or bandemia (white blood cells >1,200/mm3, <4,000/mm3 or bandemia ≥10%).
WBC, C-reactive protein (CRP) and interleukin-1 (IL-1) are the conventional markers used for diagnosis of sepsis.
Normal serum values are below 0.05 ng/mL, and a value of 2.0 ng/mL suggests a significantly increased risk of sepsis and/or septic shock. Values <0.5 ng/mL represent a low risk while values of 0.5 - 2.0 ng/mL suggest an intermediate likelihood of sepsis and/or septic shock.
A high level of lactic acid caused by infection can be an important clue that you have sepsis. C-reactive protein (CRP): Your body produces C-reactive protein is produced when there is inflammation. Several conditions can cause inflammation, including infections.
Organ failure, including kidney failure, is a hallmark of sepsis. As the body is overwhelmed, its organs begin to shut down, causing even more problems. The kidneys are often among the first to be affected.
NICE - the National Institute for Health and Care Excellence - urges hospital staff to treat people with life-threatening sepsis within one hour, in its quality standard. In clinical practice, this is often referred to as the 'golden hour' after diagnosis.
Signs suggestive of sepsis in adults
Heart rate > 90/minute. Acute confusion or decreased level of consciousness. Hyperglycemia (blood glucose > 7.7 mmol/L in patient without diabetes) Oliguria (urine output less than 0.5 mL/kg/hour)
response to an infection injures its own tissues and organs. qSOFA criteria: Alteration in mental status (GCS < 14) Hypotension - SBP ≤100 mm Hg Respiratory rate ≥22/min. increase mortality.
Blood tests
Evidence of infection. Blood-clotting problems. Abnormal liver or kidney function. Lower levels of oxygen than the body needs.
Sepsis can develop quickly from initial infection and progress to septic shock in as little as 12 to 24 hours.1 You may have an infection that's not improving or you could even be sick without realizing it.
Sepsis needs treatment in hospital straight away because it can get worse quickly. You should get antibiotics within 1 hour of arriving at hospital. If sepsis is not treated early, it can turn into septic shock and cause your organs to fail.
Preferred empiric monotherapy includes meropenem, imipenem, piperacillin-tazobactam, or tigecycline. Empiric combination therapy includes metronidazole plus levofloxacin, aztreonam, or a third- or fourth-generation cephalosporin.
Experts' recommendations currently position norepinephrine (NE) as the first-line vasopressor in septic shock.
Many conditions mimic sepsis by meeting criteria for SIRS.
These conditions include: pulmonary embolism (PE), adrenal insufficiency, diabetic ketoacidosis (DKA), pancreatitis, anaphylaxis, bowel obstruction, hypovolemia, colitis, vasculitis, toxin ingestion/overdose/withdrawal, and medication effect.
When treatment or medical intervention is missing, sepsis is a leading cause of death, more significant than breast cancer, lung cancer, or heart attack. Research shows that the condition can kill an affected person in as little as 12 hours.
“But the most common cause of sepsis is community–acquired pneumonia,” Angus says. Scientists are still working to understand why some people with infections develop severe sepsis or septic shock while others don't. Researchers are exploring new ways to diagnose, reverse, or prevent this serious and costly condition.
Values can shoot up to 300 mg/L within 2 days. In a normal individual, values are generally below 3 mg/L. Based on a research article by Coelho et al.,1 the prognosis is poor, if the CRP level is 0.5 times elevated from the baseline level by Day 2 (91% sensitivity, 59% specificity).
Carson adds: "For adults, red flag symptoms can be someone in a confused state, possibly with slurred speech. They may be shivering and feel cold, but have a temperature and clammy, sweating skin. Heart rate can be raised, and blood pressure will be lower than normal. They may also have shortness of breath.
There are three types of blood tests that can confirm sepsis, which include: Endotoxin test: The identification of endotoxin in the blood confirms the presence of gram-negative bacteria within the blood; however, the specific type of bacteria cannot be identified with this test.
Examples of sepsis misdiagnosis
Sepsis can often be misdiagnosed due to the following: Blood pressure was not obtained promptly. Serum lactate and full blood count was not measured. Symptoms of sepsis are missed or misinterpreted.