Table 4.

Evolution of sepsis, severe sepsis and septic shock definitions with clinical criteria.

	1992 ACCP/SCCM Consensus statement	Levy	2012 SCCG	NQF	CMS	Sepsis-3	2016 SCCG
SIRS	Temperature > 38°C or < 36°C Heart rate > 90 bpm Respiratory rate > 20 or PaCO2 < 32 mm Hg  White blood cell count > 12,000/cu mm, <4,000/cu mm or >10% bands	No change	No change	No change	No change	Eliminated and qSOFA introduced for purpose of risk stratification	No SIRS. No qSOFA.
Sepsis	Infection + 2 or more SIRS	No change	No change	No change	No change	Infection + 2 qSOFA criteria	Infection + end organ dysfunction. No clinical criteria offered.
Severe sepsis	Sepsis + end-organ dysfunction. No specific lactate level offered.	Sepsis + end-organ dysfunction. Lactate > 3*	Sepsis + end-organ dysfunction. Lactate > 4	No change	Sepsis + end-organ dysfunction. Lactate > 2	Eliminated	Eliminated
Septic shock	Sepsis + a SBP <90 mm Hg or a reduction of 40 mm Hg from baseline or evidence of low perfusion after adequate fluid bolus. No specific lactate level offered.	Same as 1992 with addition of MAP < 60 mm Hg despite adequate fluid bolus.	MAP threshold increased to < 70 mm Hg and fluid bolus defined as 30 mL/kg	No change	Initial lactate > 4 or SBP < 90 mm Hg after 30 mL/kg fluid bolus	SBP < 90 mm Hg AND lactate > 2 after adequate fluid resuscitation	Subset of sepsis with circulatory and cellular/metabolic dysfunction associated with a higher risk of mortality. No clinical criteria offered.

MAP, mean arterial pressure, SBP, systolic blood pressure.

^*all lactate levels in mmol/L values.