Comparison of automated Sepsis-3 algorithm and CDC adult sepsis event criteria
| Criteria | Sepsis-3 algorithm as implemented by Valik et al | CDC Adult Sepsis Event |
| Infection |
1. Any clinical culture obtained, AND
2.≥2 antibiotic doses within 6–48 hours Culture sites include abdomen, blood, bone, bronchoalveolar lavage, cerebral spinal fluid, catheters/devices, nasopharynx, pleural space, skin/tissue, sputum, stool, synovial fluid, urine. Cultures types include bacterial or C. difficile toxin, Mycoplasma pneumoniae DNA, enterohemorrhagic E. coli DNA, Legionella urine antigen, fungal cultures from blood. If antibiotic administration occurred first, a culture must be obtained within 24 hours. If a culture was obtained first, an antibiotic must be given within 72 hours. One antibiotic dose permitted if patient was admitted to the ICU prior to 24 hours, or died prior to 48 hours from the first antibiotic dose. ‘Onset of infection’ defined as the first of either event |
1. Blood culture obtained, AND
2.≥4 consecutive antibiotic days Antibiotic sequence starts with a ‘new’ antibiotic (ie, not given in prior 2 days) administered within ±2-day window around blood culture day. <4 antibiotic days permitted if patient died, was discharged to hospice or another hospital or transitioned to comfort measures before 4 days. At least one antibiotic must be parenteral. ‘Day of infection onset’ defined as the day of blood culture or first antibiotic, whichever is earlier |
| Organ Dysfunction | Increase in modified SOFA Score by ≥2 points from baseline during window of up to 48 hours before to 24 hours after onset of infection: | ≥1 of the following “eSOFA” criteria within +/-2 calendar days of blood culture day: |
| Cardiovascular |
1 - Mean arterial pressure <70 mm Hg Baseline=last measured mean arterial pressure before suspected infection window (only during current hospitalisation). Vasopressor doses not used since surveillance performed outside the ICU |
Vasopressor initiation
Specific vasopressor must not have been given in prior calendar day. Vasopressors given as bolus or in operating room excluded |
| Pulmonary |
1 - PaO2/FiO2<400 or SpO2/FiO2<512
2 - PaO2/FiO2<300 or SpO2/FiO2<357 3 - PaO2/FiO2<200, or SpO2/FiO2<214 4 - PaO2/FiO2<100, or SpO2/FiO2<89 Baseline=last PaO2 or SpO2 prior to suspected infection window during last 3 months. ICD codes for home oxygen or ventilator use in prior year=2 baseline points |
Mechanical ventilation initiation
>1 calendar day between ventilation episodes required |
| Renal |
1 - Creatinine 110–170 µmol/L
2 - Creatinine 171–299 µmol/L 3 - Creatinine 300–440 µmol/L 4 - Creatinine>440 µmol/L Baseline=last measured creatinine prior to suspected infection window during last 3 months. ICD codes for chronic dialysis=4 baseline points. Urine output not used due to data availability |
↑2x Creatinine or ↓≥50% of estimated glomerular filtration rate relative to baseline
Baseline creatinine=lowest during hospitalisation if infection onset on hospital day≤2, or lowest during ±2-day window period if infection onset on hospital day>2. Patients with ICD codes for end-stage renal disease excluded |
| Hepatic |
1 - Bilirubin 20–32 µmol/L
2 - Bilirubin 33–101 µmol/L 3 - Bilirubin 102–204 µmol/L 4 - Bilirubin>204 µmol/L Baseline=last measured bilirubin prior to suspected infection window during last 3 months |
Bilirubin≥2.0 mg/dL and ↑2x from baseline
Baseline bilirubin=lowest during hospitalisation if infection onset on hospital day≤2, or lowest during ±2-day window period if infection onset on hospital day>2 |
| Coagulation |
1 - Platelets 100–149×103/ µL 2 - Platelets 50–99×103/ µL 3 - Platelets 20–49×103/ µL 4 - Platelets<20×103 /µL Baseline=last measured platelet count prior to suspected infection window during last 3 months |
Platelet count<100×103 /µL and↓≥50% decline from baseline (baseline must be≥100) Baseline platelets=lowest during hospitalisation if infection onset on hospital day≤2, or lowest during ±2-day window period if infection onset on hospital day>2 |
| Neurologic
(SOFA) or Perfusion (eSOFA) |
1 - 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 Baseline=last measured value before suspected window (only during current hospitalisation). If Glasgow Coma Scale unavailable, structured data on ‘alert’ (0 points) or ‘not alert‘ (one point) used | Lactate≥2.0 mmol/L |
CDC, Centers for Disease Control and Prevention; FiO2, fraction of inspired oxygen; PaO2, arterial PaO2 of oxygen; SOFA, Sequential Organ Failure Assessment; SpO2, peripheral capillary oxygen saturation.