Mortality in Sepsis: Sensitivity and Specificity

Introduction: Sepsis designates a condition of systemic inflammatory response (SIRS) attributed to an infection. Depending on the severity (sepsis, severe sepsis, septic shock) it has varying degrees of mortality.

Definitions:

SIRS: Two or more of the following conditions: temperature >38.5°C or <35.0°C; heart rate of >90 beats/min; respiratory rate of >20 breaths/min or PaCO2 of <32 mm Hg; and WBC count of >12,000 cells/mL, <4000 cells/mL, or >10 percent immature (band) forms

Sepsis: SIRS + documented or presumed infection

Severe Sepsis: Sepsis and at least one of the following signs of organ hypoperfusion or organ dysfunction: areas of mottled skin; capillary refilling of 3 s; urinary output of <0.5 mL/kg for at least 1 h or renal replacement therapy; lactate >2 mmol/L; abrupt change in mental status or abnormal EEG findings; platelet count of <100,000 cells/mL or disseminated intravascular coagulation; acute lung injury/ARDS; and cardiac dysfunction (echocardiography)

Septic Shock: Severe sepsis and one of the following conditions: systemic mean BP of <60 mm Hg (<80 mm Hg if previous hypertension) after 20 to 30 mL/kg starch or 40 to 60 mL/kg saline solution, or PCWP between 12 and 20 mm Hg; OR need for dopamine of >5 mcg/kg/min, or norepinephrine or epinephrine of <0.25 mcg/kg/min to maintain mean BP at >60 mm Hg (80 mm Hg if previous hypertension)

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Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Sepsis	16%	JAMA 1995 Jan 11;273(2):117-23. PMID 7799491
Severe Sepsis	20%	JAMA 1995 Jan 11;273(2):117-23. PMID 7799491
Septic Shock	46%	JAMA 1995 Jan 11;273(2):117-23. PMID 7799491
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The sensitivity and specificity of findings for Mortality in Sepsis are listed below. See the left navigation bar to change the display.

Specific Findings

Elevated Serum Lactate
Duplicate

36%

92%

>=4 mmol/L in ED in infected patients on whom a lactate was drawn -> death within 28 days

Study: Ann Emerg Med. 2005 May;45(5):524-8. PMID: 15855951

Elevated Serum Lactate
Duplicate

55%

91%

>= 4mmol/L in ED in infected patients on whom a lactate was drawn -> death within 3 days

Study: Ann Emerg Med. 2005 May;45(5):524-8. PMID: 15855951

Poorly Diagnostic Findings

Persistently Elevated Serum Lactate

44.7%

84.4%

Failure to decrease lactate by >=10% in the first 6 hours for patients in severe sepsis or septic shock.

There was an approximately 11% decrease likelihood of mortality for each 10% increase in lactate clearance.

for in-hospital death

Study: Crit Care Med. 2004 Aug;32(8):1637-42. PMID: 15286537