Mortality in Sepsis: Likelihood Ratios

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 likelihood ratios of findings for Mortality in Sepsis are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Elevated Serum Lactate
Duplicate

6.1

0.5

>= 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

Good Positive Likelihood Ratio

Elevated Serum Lactate
Duplicate

4.5

0.7

>=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

Persistently Elevated Serum Lactate

2.9

0.7

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