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Evaluation

Age of patient

years

Gender of patient

PaO2 on room air (FIO2 0.21)

Is ventilatory support needed to maintain adequate oxygenation?

Systolic arterial pressure

mm Hg

Is continuous infusion of vasopressor or inotropic agents required to maintain systolic pressure > 90 mm Hg?

Does the patient show evidence of hypovolemia?

Central venous pressure

mm Hg

Serum creatinine

Minimum urine output in 8 hours

mL

24 hour urine output

mL

Does the patient require hemodialysis or peritoneal dialysis?

Was the patient on chronic hemodialysis prior to hospital admission?

Lowest Glasgow coma scale in the absence of sedation at any time during day

Did the patient experience the sudden onset of confusion or psychosis?

Serum bilirubin

Alkaline phosphatase

Upper limit of normal for alkaline phosphatase for age and gender

Hematocrit (enter from 0 to 100)

percent

White blood cell count

Platelet count

Is there clinical evidence of infection?

Number of positive blood cultures

Is there evidence of an abscess, peritonitis or empyema?

Is there an identified site of significant infection?

Results

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