Assessment criteria in identifying the sick sepsis patient.
Standard definitions of sepsis have been proposed and have been widely adopted. Recognition of the systemic inflammatory response syndrome (SIRS) and assessment of its severity can easily be achieved at the bedside using basic observations and simple laboratory tests. Fulfillment of standardized criteria defining increasing severity of sepsis or manifestation of two, three and four SIRS criteria directly correlates with risk of mortality and progression to organ failure. However, manifestation of only two SIRS criteria identifies patients who may have relatively mild disease. Furthermore, sepsis definitions take no account of pre-existing illness, source of infection or causative agent, all of which have a significant influence on outcome. Despite these limitations, manifestation of four SIRS criteria or the persistence of markers of severe sepsis identifies individuals on general wards who are at particularly high risk of death, who should be closely monitored for deterioration and discussed with an intensive-care physician at an early stage. If the source of sepsis is not clear, empirical antibiotic therapy for such individuals should be discussed with a medical microbiologist or infectious diseases physician.