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An in-depth analysis of sepsis, including its criteria, older and consensus definitions, pathogenesis, and treatment. It covers the organ dysfunction assessment (SOFA) score, qSOFA criteria for suspected infection, and the clinical criteria for septic shock. The document also discusses the limitations of SIRS and the role of late-acting mediators such as HMGB1 and MIF in the pathogenesis of sepsis and MODS.
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Definitions Epidemiology Pathophysiology Treatment Future directions
Evidence of SIRS accompanied by known or suspected infection. Severe SEPSIS : Sepsis accompanied by hypoperfusion or organ dysfunction. Cardiovascular : SBP<90 mmhg/MAP<70 for at least 1 hr despite adequate volume resuscitation or the use of vasopressors to achieve the same goals. Renal : Urine output <0.5 ml/kg/hr or Acute Renal Failure. Pulmonary : PaO2/FiO2 <250 if other organ dysfuncton is present or <200 if the lungs is the only dysfunctional organ.
Severe SEPSIS (contd) : Gastrointestinal : Hepatic dysfunction (hyperbilirubinemia,Elevated transaminases CNS : Alteration in Mental status (delirium) Hematologic : Platelet count of <80,000/mm3 or decreased by 50% over 3 days/DIC Metabolic : PH<7.30 or base deficit >5.0 mmol/L Plasma lactate >1.5 upper limit of normal. Septic Shock : Severe Sepsis with persistent hypoperfusion or hypotension despite adequate fluid resuscitation
Current estimates suggest that over 750,000 cases of Sepsis are diagnosed annually, resulting in more than 200,000 deaths. The incidence rate for Sepsis has been increasing over the past two decades, driving an increase in the number of deaths despite a decline in case-fatality rates. Sepsis is the tenth leading cause of death in the United States and accounts for more than 17 billion dollars in direct healthcare expenditures. Risk factors include age > 65 years, male, non- whites. A primary site of infection cannot be established in 10% of patients with severe Sepsis/SIRS.
Epidemiology : Causative organism