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. Author manuscript; available in PMC: 2016 Feb 5.
Published in final edited form as: Infect Control Hosp Epidemiol. 2015 Nov 3;37(2):163–171. doi: 10.1017/ice.2015.264

TABLE 1.

Comparison of the International Consensus Definition of Severe Sepsis and Surveillance Definition Based on Electronic Health Record (EHR) Clinical Data

Severe Sepsis Consensus Definitiona EHR Clinical Surveillance Definition
Sepsis
  • 1

    Suspected or documented infection +

  • 2

    ≥2 systemic inflammatory response syndrome criteria:

    • Temperature >38.3°C or <36° C

    • Heart rate >90 beats/min

    • Respiratory rate >20 breaths/min or mechanical ventilation or pCO2 <32mm Hg

    • White blood cell count >12,000 or <4,000 μL, or >10% bands +
  • 1

    Blood culture order +

  • 2

    New intravenous antibiotic followed by any systemic antibioticb every day for total ≥4 antibiotic days (or until 1 day prior to discharge or death) +
Organ Dysfunction
  • 3

    Any of the following thought to be due to sepsis:

    • Hypotension (systolic blood pressure <90mm Hg or drop by >40mm Hg, or mean arterial pressure <65mm Hg)

    • Serum lactate ≥2.0 mmol/L

    • Acute lung injury with PaO2/FiO2 <250 in the absence of pneumonia as infection source, or <200 in the presence of pneumonia as infection source

    • Urine output <0.5 mL/kg/hr for more than 2 hours despite adequate fluid resuscitation

    • Creatinine increase by ≥0.5 mg/dL from baseline

    • Total bilirubin ≥2 mg/dL

    • Platelet count <100,0000 μL

    • Coagulopathy (INR >1.5
  • 3

    ≥ 1 organ dysfunction marker:

    • Any vasopressorc

    • Initiation of mechanical ventilation, continued for ≥2 continuous calendar days (or 1 day if death occurs that day)

    • Creatinine increase by ≥0.5 mg/dL from baselined (excluding patients with end-stage renal diseasee)

    • Total bilirubin ≥2.0 mg/dL and increase by 100% from baselined

    • Platelet count <100 μL and ≥50% decline from baselined

    • INR >1.5 and ≥0.5 increase from baselined (excluding patients on warfarinf)

    • (Serum Lactate ≥2.0 mmol/L)g

      EHR Clinical Surveillance Definition fulfilled if criteria 2 and 3 occur within ±2 days of blood culture order

NOTE. INR, international normalized ratio.

a

Adapted from the 1991 American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee, 2001 Society of Critical Care Medicine/ European Society of Intensive Care Medicine/American College of Chest Physicians/ American Thoracic Society/ Surgical Infection Society International Sepsis Definitions Conference, and 2012 Surviving Sepsis Campaign Guidelines.

b

New intravenous antibiotic defined by washout period of 2 days. Any subsequent oral antibiotic also requires washout period of 2 days.

c

Vasopressor=norepinephrine, dopamine, vasopressin, epinephrine, phenylephrine.

d

Baseline values are defined as lowest for creatinine, bilirubin, and INR from day −30 of hospitalization admission to day of discharge, or the highest for platelets from day −30 of admission to day of discharge.

e

End-stage renal disease defined by International Classification of Diseases, Ninth Revision, Clinical Modification code of 585.6.

f

Any order for warfarin from day −30 of admission to day of hospital discharge.

g

Serum lactate was not included in the primary surveillance definition, but was included in a secondary definition.