Dionigi et al used a modification of the sepsis score of Elebute and Stoner to grade surgical sepsis in the intensive care unit (ICU). This help identify patients with serious infections who may benefit from more aggressive therapy. The authors are from the University of Pavia in Italy.
4 attributes of sepsis:
(1) local effects of tissue infection
(2) pyrexia
(3) secondary effects of sepsis
(4) laboratory findings
Modifications from the sepsis score of Elebute and Stoner:
(1) local effects: addition of points for tube drainage
(2) local effects: addition of points for urinary tract infection
(3) laboratory findings: change in point assignments for leukocyte count
Local Effects of Tissue Infection
|
Attribute |
Finding |
Score |
|---|---|---|
|
wound infection with purulent discharge and/or enterocutaneous fistula |
requiring only light dressing changed not more than once daily |
2 |
|
|
requiring to be dressed with a pack, dressing needing to be changed more than once a day, requiring application of a bag and/or requiring suction |
4 |
|
|
none |
0 |
|
peritonitis |
localized |
2 |
|
|
generalized |
6 |
|
|
none |
0 |
|
chest infection |
clinical or radiological signs of chest infection without productive cough |
2 |
|
|
clinical or radiological signs of chest infection with a cough producing purulent sputum |
4 |
|
|
full clinical manifestations of lobar or bronchopneumonia |
6 |
|
|
none |
0 |
|
deep seated infection |
subphrenic abscess, pelvic abscess, empyema thoracis, acute or chronic osteomyelitis |
6 |
|
|
none |
0 |
|
infection requiring tube drainage |
present |
4 |
|
|
absent |
0 |
|
urinary tract infection |
clinical signs of pyelonephritis |
4 |
|
|
clinical signs of lower urinary tract infection and/or positive urine culture |
2 |
|
|
absent |
0 |
where:
• A positive urine culture does not include those with contaminants only.
score local effects =
= (points for wound infection) + (points for peritonitis) + (points for chest infection) + (points for deep seated infection) + (points for tube drainage) + (points for urinary tract infection)
minimum score: 0
maximum score: 30
Pyrexia (Oral Temperature)
|
Attribute |
Finding |
Score |
|---|---|---|
|
maximum daily temperature |
> 39 °C |
3 |
|
|
38.5 - 39° C |
2 |
|
|
37.5 - 38.4 °C |
1 |
|
|
36 - 37.4 °C |
0 |
|
|
< 36° C |
3 |
|
minimum daily temperature |
> 37.5° C |
1 |
|
|
<= 37.5 |
0 |
|
number of temperature peaks > 38.4° C in 1 day |
>= 2 |
1 |
|
|
0 or 1 |
0 |
|
number of rigors that occur in a day |
>= 1 |
1 |
|
|
0 |
0 |
score for pyrexia =
= (points for maximum daily temperature) + (points for minimum daily temperature) + (points for number of temperature peaks) + (points for rigors)
minimum score: 0
maximum score: 6
Secondary Effects of Sepsis
|
Attribute |
Finding |
Score |
|---|---|---|
|
obvious jaundice in the absence of established hepatobiliary disease |
present |
2 |
|
|
absent |
0 |
|
metabolic acidosis |
compensated |
1 |
|
|
uncompensated |
2 |
|
|
absent |
0 |
|
renal failure |
present |
3 |
|
|
absent |
0 |
|
gross disturbance of mental orientation/ level of consciousness |
delirium, coma) and/or other focal neurological manifestations of pyemia or septicemia, having excluded other causes |
3 |
|
|
absent |
0 |
|
bleeding diathesis |
associated with disseminated intravascular coagulation (DIC) |
3 |
|
|
not associated with DIC |
0 |
score for secondary effects of sepsis =
= (points for jaundice) + (points for acidosis) + (points for renal failure) + (points for mental disturbance) + (points for bleeding diathesis)
minimum score: 0
maximum score: 13
Scoring of Laboratory Data
|
Attribute |
Finding |
Score |
|---|---|---|
|
blood culture |
negative |
0 |
|
|
single positive culture |
1 |
|
|
two or more positive cultures separated by 24 hours |
3 |
|
|
single positive culture plus history of invasive procedure |
3 |
|
|
single positive culture plus cardiac murmur and/or tender enlarged spleen |
3 |
|
leukocyte count |
> 25,000 per µL |
3 |
|
|
15,001 – 25,000 |
2 |
|
|
9,001 - 15,000 per µL |
1 |
|
|
3,000 - 9,000 per µL |
0 |
|
|
< 3,000 per µL |
3 |
|
hemoglobin level in absence of obvious bleeding |
> 10 g/dL |
0 |
|
|
7 - 10 g/dL |
1 |
|
|
< 7 g/dL |
2 |
|
platelet count |
> 150,000 per µL |
0 |
|
|
100,000 - 150,000 per µL |
1 |
|
|
< 100,000 per µL |
2 |
|
plasma albumin |
> 3.5 g/dL |
0 |
|
|
3.1 - 3.5 g/dL |
1 |
|
|
2.5 - 3.0 g/dL |
2 |
|
|
< 2.5 g/dL |
3 |
|
plasma total bilirubin level in the absence of clinically obvious jaundice |
<= 25 µmol/L (1.46 mg/dL) |
0 |
|
|
> 25 µmol/L |
1 |
score for laboratory data =
= (points for blood culture) + (points for leukocyte count) + (points for hemoglobin) + (points for platelet count) + (points for albumin) + (points for total bilirubin)
minimum score: 0
maximum score: 14
Aggregate Score
aggregate score =
= (score for local effects) + (score for pyrexia) + (score for secondary effects) + (score for laboratory data)
Interpretation:
• minimum score: 0
• maximum score: 63
• 82% of patients with an initial aggregate sepsis score < 20 progressively improved and survived.
• 6% of patients with an initial aggregate sepsis score >= 20 survived.
Limitations:
• The survival data may have improved since 1985. However, the general prognostic groups (good vs poor) are probably still relevant.
Specialty: Infectious Diseases
ICD-10: ,
