KAMRAN YOUSAF FCPS,MRCS MEEQAT HOSPITAL MADINA MUNAWARA

1. SEPSIS SCORING
KAMRAN YOUSAF
FCPS,MRCS
MEEQAT HOSPITAL MADINA MUNAWARA

3.  INTERNATIONAL CONSENSUS ON SEPSIS AND SEPTIC
SHOCK,,,,,1991 TO 2001 AND 2004
 2004 THROUGH 2008 SURVIVING SEPSIS
CAMPAIGN,SSC
 THIRD INTERNATIONAL CONSENSUS ON SEPSIS
,,,2016
 HOUR-1 UPDATE 2018
HISTORICAL PERSPECTIVE

4.  AFFECTS MILLIONS AROUND THE GLOBE
 LOADS OF STUDIES ON EPIDEMIOLOGY,,,SIMPLE
EQUATION IS THAT THE DISEASE HAS RISEN FROM
THOUSANDS PER YEAR IN MAJOR CLINICAL SETTINGS TO
OVER A MILLION AND A HALF PER YEAR IN THE LAST 40-
50 YEARS.
 ECONOMIC BURDEN,,,20 BILLION USD IN US AND KSA ???
 MAJOR CAUSE OF MORTALITY,,,30-50 % FOR SEP SHOCK
AND 20-30 % FOR SEPSIS
MAJOR HEALTH CARE ISSUE

5.  ITS AS IMPORTANT AS A CASE OF POLYTRAUMA IN
ER
 OR A CASE OF ACUTE MI
 OR A PATIENT WITH STROKE
ACUTE MD EMERGENCY,,,,,,PARAMOUNT IMP
MAGNITUDE OF PROBLEM

6.  PRIMARY CAUSE OF DEATH FROM INFECTION ESP IF
NOT RECOGNISED EARLY
 A SYNDROME SHAPED BY PATHOGEN FACTOR AND
HOST FACTOR
 SEPSIS INDUCED ORGAN DYSFUNCTION MAY BE
OCCULT,,,
 UNEXPLAINED ORGAN DYSFUNCTION----UNDERLYING
SEPSIS
KEY CONCEPTS OF SEPSIS

7.  SITE OF INFECTION,,,,,,,,RTI 44-60 %
 ,,,ABDOMEN 26%
 ,,,BLOODSTREAM 20%
 ,,,URIN SYSTEM 12-20 %
 ,,,,SKIN/SOFT TISSUE 14%
 NO DEFINITE SOURCE IN 20-30 %
KEY CONCEPTS

8.  GRAM POITIVE REMAIN THE MOST FREQUENT
 GRAM NEGATIVE SUBSTANTIAL
 FUNGAL SEPSIS IS ON THE RISE BUT REMAINS
LOWER THAN THE BACTERIAL
 IN ALMOST HALF THE CASES NO PATHOGEN IS
IDENTIFIED (CULTURE NEGATIVE SEPSIS)
THE PATHOGENS

9.  PATHOGEN VARY,,,REGION,HOSPITAL
SIZE,SEASON,TYPE OF UNIT ETC
 90 % OF IDENTIFIED PTHOGENS ARE GRAM POSITIVE
AND NEGATIVE
 SINCE MID 80’S,,,G POS SURPASED THE G NEG SEPSIS
 G POS CN STAPH AUREUS,ENTERO,STREP
 G NEG E COLI,KLEB PNEUM,PSEUDOM
 E COLI REMIANS THE MOST PREVLANT SINGLE
PATHOGEN
PATHOGENS,,,CONT-D

10.  INCIDENCE,,,,,EVER RISING NO OF PATIENTS
 HOSPITALIZATION,,,BED OCCUPANCY BY SEPSIS
RELATED PTIENTS HAS RISEN SHARPLY
 COST/ECONOMIC BURDEN,,,HEFY AMOUNT OF
MONEY AND HUMAN RESOURCES BEING SPENT ON
THEM
 MORTALITY,,,,ONE OF EVERY FOUR PATIENTS WILL
DIE
ENOUPH???

11.  SEPSIS HAS BEEN REDEFINED AS LIFE-THREATENING
ORGAN DYSFUNCTION CAUSED BY A DYSREGULATED
HOST RESPONSE TO A NEW INFECTION.
 SEPTIC SHOCK HAS ALSO BEEN REDEFINED AS A
SUBSET OF SEPSIS IN WHICH PARTICULARLY
PROFOUND CIRCULATORY, CELLULAR, AND METABOLIC
ABNORMALITIES ARE ASSOCIATED WITH A GREATER
RISK OF MORTALITY THAN WITH SEPSIS ALONE
NEW DEFINITIONS

12. PREDICT ORGAN DYSFUNCTION AND MORTALITY
BETTER
WHY SCRING SYSTEMS ?

13. WHICH SCORING SYTEM?

14. • "THE SOFA SCORE FOUND PATIENTS MORE LIKELY TO
BE SEPTIC BOTH IN AND OUT OF THE ICU. BUT IT
INVOLVES THE USE OF MANY LAB TESTS AND IS A BIT
COMPLEX.
• FOR PATIENTS NOT IN THE ICU, THE PERFORMANCE OF
QUICK SOFA SCORE WAS SIMILAR TO THAT OF THE
SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE.
CHOOSING THE SCORING SYATEM

15.  IN THE OLD CRITERIA FOR SEPSIS, SIRS SCORE WAS A
MEASURE OF RESPIRATORY RATE, WHITE BLOOD
CELL COUNT, HEART RATE, AND FEVER.
• THE SEQUENTIAL ORGAN FAILURE ASSESSMENT
SCORE( SOFA ) AND THE LOGISTIC ORGAN
DYSFUNCTION SYSTEM SCORE ( LODS ) ARE MORE
RECENT ,PREDICT ORGAN DYSFUNCTION AND
MORTALITY BETTER

16. MODIFIED VERSION OF SOFA,
BEDSIDE WITH QSOFA,
▫ RESPIRATORY RATE ≥22/MIN
▫ ALTERED MENTATION
▫ SYSTOLIC BLOOD PRESSURE ≤ 100MMHG
THE PRESENCE OF AT LEAST TWO OF THESE CRITERIA
STRONGLY PREDICTS THE LIKELIHOOD OF POOR
OUTCOME IN OUT-OF-ICU PATIENTS WITH CLINICAL
SUSPICION OF SEPSIS.
IDENTIFICATION OF EARLY SEPSIS
QSOFA

17.  HITORIC,,,,,,SIRS
 Q SOFA
 TRACT AND TRIGGER WARNING SCORE,,,MEWS
SCORING SYSTEM
THE SCREENING PROMPTS

20. SIRS IS STILL RELEVANT?
 IT HELP IDENTIFY THE SOURCE OF INFECTION
 PRESENCE OF 2 SIRS CRITERIA WILL DIG OUT THE
UNCOMPLICATED SEPSIS

23.  SIRS
 Q SOFA
 MEWS
 NEWS (UK)
HISTORIC SCORING LADDER

24.  SEPSIS
 SEPSIS BUNDLES AND SSC
 SEPTIC SHOCK
 SIRS
 SCREENING PROMPTS,,,SCORING SYSTEMS
 RED FLAG SEPSIS
 AMBER FLAG SEPSIS
TERMINOLOGY

25. Thank you