Table 2.

Criteria for severe sepsis. Sepsis plus any one of the following:

1. Cardiovascular dysfunction:

Despite administration of isotonic intravenous fluid bolus of ≥40 ml/kg in 1 h: Decrease in blood pressure to <5th percentile for age or blood pressure at <2 SDs below normal for age; or Need for vasoactive drug to maintain blood pressure in the normal range (dopamine > 5 mcg/kg/min or dobutamine, epinephrine, or norepinephrine at any dose); or

Any two of the following

Unexplained metabolic acidosis (base deficit > 5.0 mEq/l);

Increased arterial lactate at >2 times the upper limit of normal;

Oliguria (urine output < 0.5 ml/kg per h);

Prolonged capillary refill (>5 s); or

Core-to-peripheral temperature differential of > 3 °C

2. Respiratory

PaO2/FiO2 < 300 in absence of cyanotic heart disease or preexisting lung disease; or

PaCO2 > 65 torr or 20 mm Hg over baseline PaCO2; or

Proven need or 0.5 FIO2 to maintain saturation at ≥92 %; or

Need for non-elective invasive or non-invasive mechanical ventilation

3. Neurologic

Glasgow Coma Score ≤ 11; or

Acute change in mental status with a decrease in Glasgow Coma Score of ≥3 points from abnormal baseline

4. Hematologic

Platelet count < 80,000/μl or a decline of 50 % in platelet count from highest value recorded over the past 3 days (for patients with chronic thrombocytopenia); or

International normalized ratio > 2

5. Renal

Serum creatinine level ≥2 times the upper limit of normal for age or twofold increase in baseline creatinine level

6. Hepatic

Total bilirubin concentration ≥ 4 mg/dl (excepting newborns); or

ALT 2 times upper limit of normal for age

Note: Criteria for septic shock

Sepsis with hypotension (two distinct measurements of blood pressure < 3rd percentile for age) after administration of 40 ml/kg of crystalloid or colloid, plus any one of the following:

1. Requirement for inotropic or vasopressor support (excluding dopamine < 5 μg/kg/min)

2. Any of the cardiovascular diagnostic criteria for severe sepsis listed above