Table 1

Adult Sepsis Event criteria and comparison with Sepsis-3 and SEP-1 criteria

Sepsis-3 (EHR version)*CMS ‘SEP-1’ Severe SepsisCDC Adult Sepsis Event
Infection
  1. Body fluid culture obtained†, AND

  2. Administration of ≥2 doses of antibiotics

If a culture was obtained first, an antibiotic must be given within 72 hours. If antibiotic administration occurred first, a culture must be obtained within 24 hours
  1. Documentation of suspected or confirmed infection

  2. 2 SIRS criteria (within 6 hours): temperature >38.3°C or <36.0°C; heart rate >90 beats/minute; respirations >20/minute; white blood cell count >12 or <4×109 cells/L or >10% bands

  1. Blood culture obtained, AND

  2. New antibiotic starting within ±2 days of blood culture day, followed by a total of ≥4 consecutive antibiotic days (or until <=1 day prior to death, discharge to hospice or acute care hospital, or transition to comfort care)‡

Organ dysfunctionIncrease in SOFA score by ≥2 points from up to 48 hours before to up to 24 hours after onset of infection (body fluid culture or antibiotic administration, whichever occurred first):One of more of the following, within 6 hours of documentation of infection and SIRS (excluding organ dysfunction documented as chronic):One or more of the following criteria within ±2 calendar days of blood culture day:
Cardiovascular1. Mean arterial pressure <70 mm Hg
2. DA ≤5 µg/kg/min or any dobutamine
3. DA >5 or EPI ≤0.1 or NE ≤0.1 µg/kg/min
4. DA >15 or EPI >0.1 or NE >0.1 µg/kg/min
  • Systolic blood pressure <90 mm Hg (or decrease by >40 mm Hg) or mean arterial blood pressure <65 mm Hg

  • Vasopressor initiation (NE, EPI, DA, phenylephrine or vasopressin)§

Pulmonary1. PaO2/FiO2 300–399
2. PaO2/FiO2 200–299
3. PaO2/FiO2 100–199 and ventilated
4. PaO2/FiO2 <100 and ventilated
  • Respiratory distress requiring initiation of mechanical ventilation or non-invasive positive pressure ventilation

  • Mechanical ventilation initiation (>1 calendar day required between ventilation episodes)

Renal1. Creatinine 1.2–1.9 mg/dL
2. Creatinine 2.0–3.4 mg/dL
3. Creatinine 3.5–4.9 mg/dL or <500 cc urine/day
4. Creatinine >5.0 mg/dL or <200 cc urine/day
  • Creatinine >2.0 mg/dL or urine output <0.5 mL/kg/hour for 2 hours

  • ↑2× Creatinine or ↓≥50% of eGFR relative to baseline¶ (excluding patients with end-stage renal disease)

Hepatic1. Bilirubin 1.2–1.9 mg/dL
2. Bilirubin 2.0–5.9 mg/dL
3. Bilirubin 6.0–11.9 mg/dL
4. Bilirubin >12.0 mg/dL
  • Bilirubin >2 mg/dL

  • Bilirubin ≥2.0 mg/dL and ↑2× from baseline¶

Coagulation1. Platelets 100–149×109 cells/L
2. Platelets 50–99×109 cells/L
3. Platelets 20–49×109 cells/L
4. Platelets <20×109 cells/L
  • Platelet count <100×109 cells/L, or

  • INR >1.5 or aPTT >60 s

  • Platelet count <100×109 cells/L and ↓≥50% decline from baseline¶ (baseline must be ≥100)

Neurological (or perfusion1. Glasgow Coma Scale score 13–14
2. Glasgow Coma Scale score 10–12
3. Glasgow Coma Scale score 6–9
4. Glasgow Coma Scale score <6
  • Lactate >2.0 mmol/L

  • Lactate ≥2.0 mmol/L**

  • *Sepsis-3 EHR criteria are as defined by Seymour et al in the Sepsis-3 clinical criteria derivation analyses.15

  • †Body fluid culture sites include abdomen, bronchoalveolar lavage, blood, bone, cerebrospinal fluid, catheters/devices, pleural space, skin/soft tissue, stool and urinary tract. Culture types include bacterial, fungal, viral, parasitic and Clostridium difficile toxin testing.

  • ‡A new antibiotic refers to one not given in the prior two calendar days. At least one antibiotic given within ±2 days of the blood culture day must be parenteral.

  • §To count as a new vasopressor, that specific vasopressor cannot have been administered in the prior calendar day. Vasopressors given by bolus injection or in the operating room (or other procedural areas where anaesthesia is administered) are excluded.

  • ¶For presumed infection present-on-admission (blood culture day or first antibiotic occurring on hospital day 1 or 2), baseline laboratory values are defined as the best values during hospitalisation. For hospital-onset infection (blood culture day and first antibiotic occurring on hospital day ≥3), baseline laboratory values are defined as the best values during the ±2-day period surrounding the day of the blood culture draw.

  • **Serum lactate captures more patients with sepsis but carries risk of ascertainment bias if rates of lactate testing in a hospital are increasing over time.

  • CDC, Centers for Disease Control and Prevention; CMS, Centers for Medicare and Medicaid Services; DA, dopamine; EHR, electronic health record; EPI, epinephrine; FiO2, fraction of inspired oxygen; INR, international normalised ratio; NE, norepinephrine; PaO2, arterial partial pressure of oxygen; SIRS, systemic inflammatory response syndrome; SOFA, Sequential Organ Failure Assessment; aPTT, activated partial thromboplastin time; eGFR, estimated glomerular filtration rate.