Septic Shock Symptoms & Score | Medical Algorithm

Description

Patients with septic shock have an increased mortality rate. The Simplified and Complete Septic Shock Scores are derived from clinical variables and correlate with the mortality rates seen. The Simplified Score can be derived early in the patient course. The Complete Score is more specific but requires culture results, which may take a day or more to collect. This system can be used for septic shock patients in lieu of the APACHE or SAPS scoring systems.

Score Basics: Variables having prognostic significance are identified and graded 0, 1 or 2, with higher points indicating a more significant abnormality.

Simplified Septic Shock Score

Points for Calculating the Simplified Septic Shock Score

Variable	Finding	Points
age in years	< 65	0
	65-69	1
	>= 70	2
sex (male or female)	female	0
	male	1
mechanical ventilation	no	0
	yes	1
Glasgow Coma Scale	>= 13	0
	< 13	2
diuresis (mL/hr)	>= 20	0
	< 20	1
body temperature °C	< 37	2
	37 - 39.5	0
	>= 39.5	1
hematocrit as a percent	>= 25	0
	< 25	2
WBC count per µL, in thousands	< 1.5	1
	1.5 - 24.9	0
	25-39.9	1
	>= 40	2
pH	< 7.10	2
	7.10-7.24	1
	7.25-7.49	0
	>= 7.50	2
prothrombin time in seconds	>= 23	0
	< 23	1
heart rate in beats per minute	< 80	2
	80 - 169	0
	>= 170	2
mean arterial pressure	>= 70	0
	50 - 69	1
	< 50	2
mean pulmonary artery pressure	< 35	0
	>= 35	1
cardiac index in L/min per meter squared	< 3.5	2
	3.5 - 6.4	0
	6.5 - 7.4	1
	>= 7.5	2

where:

• prothrombin time is measured with a thromboplastin having an ISI (International Sensitivity Index) of 1.16.

Simplified Septic Shock Score =

= SUM (points for each of the 14 variables)

Complete Septic Shock Score

Additional Points for Calculating the Complete Septic Shock Score

Type	Condition	Points
underlying disease	liver cirrhosis	2
	pre-existing heart failure NYHA functional class III or IV	2
	chronic pulmonary failure	2
	chronic renal failure	2
	immunocompromising condition	1
type of infection	polymicrobic blood culture	2
	infection due to Pseudomonas aeruginosa	2
	pneumonia as primary focus of infection	1

Immunocompromising condition involves EITHER:

(1) the patient has received therapy that suppresses resistance to infection, such as immunosuppression, chemotherapy, radiation, long-term or recent high dose steroids OR

(2) the patient has an underlying disease that is sufficiently advanced to suppress resistance to infection, such as leukemia, lymphoma, or acquired immunodeficiency syndrome

additional point score =

= SUM (points for each of the 8 variables)

Complete Septic Shock Score =

= (simplified septic shock score) + (sum of additional points)

Interpretation

Scores:

• maximum simplified septic shock score: 23

• maximum complete septic shock score: 23 + 14 = 37

• minimum scores: 0

Mortality rate from Scores

Score	Simplified	Complete
0	0	0
1	4	1
2	10	4
3	22	9
4	42	21
5	66	42
6	82	65
7	92	85
8	97	93
9	99	97
10	100	99
11	100	100

extrapolated from Figure 1, page 958 (Baumgartner, 1992)

According to the data Figure 1, mortality rate can be determined from the score by use of the following equation:

mortality rate for simplified score =

= EXP(a + (b * (score))) / (1 + EXP(a + (b * (score))))

	a	b
simplified score	1.01	-5.33
complete score	0.94	-4.01

Unfortunately, when these equations are used, the output does not correlate with the data shown in Figure 1. Reversing the assignments for a and b give more credible results, but do not match the data in Figure 1.

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Description

Specialty

Objective

ICD-10

Septic Shock Score

Purpose: To use the Simplified and Complete Septic Shock Scores to evaluate a patient with septic shock.

Description

Specialty

Objective

ICD-10