Sepsis comes from Greek word meaning, to make rotten. Think septic tank.
Sepsis is an infection (suspected or confirmed) plus two of the following:
S-Sleepy, difficult to wake up, or confused: Altered Mental Status (any GCS less than 15)
E-Expiring and inspiring too much: RR>20 or PaCO2 <32 / Edema or positive fluid balance (>20 mL/kg over 24 hours)
P-Pulse >90 / pressures <90
S-Shivering (cold) or Fever: T >38.3 or <36
I-Inflammatory markers: 1) WBC >12000 or <4000 or normal WBC but >10% bands; 2) CRP > 2 SD above normal; Procalcitonin > 2 SD above normal
S-Sugars are elevated: plasma glucose >140 mg/dL or 7.7 mmol/L) in the absence of diabetes
The new sepsis definition and qSOFA
Systolic BP is low: SBP < 100
Encephalopathy: Altered mental status (any GCS less than 15). Check out this ACP discussion on encephalopathy.
Pulmonary signs – Respiratory rate: RR > 22
S-Shivering (cold) or Fever: T >38.3 or <36
I-Inflammatory markers: 1) WBC >12000 or <4000 or normal WBC but >10% bands; 2) CRP > 2 SD above normal; Procalcitonin > 2 SD above normal
S-Sugars are elevated: plasma glucose >140 mg/dL or 7.7 mmol/L) in the absence of diabetes
CURB-65 / CRB-65 and qSOFA
The three parameters to look for in qSOFA are the same as in CRB-65, just slightly different numbers. It’s interesting that respiratory infections cause about 50% of all sepsis and CRB-65 is a tool for deciding whether to treat a CAP patient as an outpatient or inpatient. NB: It’s just a tool and your clinical judgment can override it.
Also, most sepsis and septic shock occur in patients over 65 years old. This makes the new qSOFA seem like just a rehashing of the CURB-65 or a worsening of it.