Sun28November0440PM 43

A 35-year-old woman presents to the critical care unit with a short history of dysuria and feeling hot and shivery.

On examination her temperature is 39.5°C; pulse rate is 130 beats per minute, respiratory rate of 30 breaths per minute and blood pressure 105/48 mmHg.

Intravenous fluid and antimicrobial therapy has been initiated.

The following biochemical and haematological tests are available:

Haemoglobin 126 g/L (115-165)

White cell count 3.6 ×109/L (4-11)

Platelet count 150 ×109/L (150-400)

Creatinine 150 µmol/L (60-110)

Bilirubin 45 µmol/L (1-22)

Which of the following values in this patient score one point in a quick Organ Failure Assessment (SOFA) or q SOFA score?

(Please select 1 option)

White cell count

Serum creatinine

Respiratory rate This is the correct answer

Temperature Incorrect answer selected

Serum bilirubin

Explanation

Severe sepsis is defined as the presence of sepsis (that is, systemic inflammatory response syndrome [SIRS] + demonstrated or suspected infection) with evidence of hypoperfusion or organ dysfunction, in this case liver dysfunction. The blood pressure is low but does not meet the criteria for severe sepsis, that is, less than 90 mmHg.

SIRS is confirmed if any of two of the following are present:

Fever of more than 38°C or less than 36°C

Heart rate of more than 90 beats per minute

Respiratory rate of more than 22 breaths per minute or arterial carbon dioxide tension (PaCO2) of less than 32 mm Hg

Abnormal white blood cell count (>12,000/µL or <4,000/µL or >10% immature [band] forms)

Blood glucose >7.7 mmol/L (in the absence of diabetes).

Sequential (sepsis-related) Organ Failure Assessment (SOFA)

Organ dysfunction can be identified as an acute change in total SOFA score (equal or more than 2 points) consequent to the infection.

The baseline SOFA score can be assumed to be zero in patients not known to have preexisting organ dysfunction.

A SOFA score 2 reflects an overall mortality risk of approximately 10% in a general hospital population with

suspected infection. Even patients presenting with modest dysfunction can deteriorate further, emphasizing the seriousness

of this condition and the need for prompt and appropriate intervention, if not already being instituted.

Parameters used for a SOFA score include:

Respiratory system (PaO2/FiO2 ratio)

Nervous system (GCS)

Cardiovascular system (Mean arterial pressure or administration of inotropes)

Liver (Bilirubin)

Coagulation (Platelet count)

Renal system (Creatinine or urine output)

The Quick SOFA Score (qSOFA) was introduced by the Sepsis-3 group in February 2016 as a simplified version of the SOFA Score as an initial way to identify patients at high risk for poor outcome with an infection.

Low blood pressure (systolic equal or less than 100mmHg): 1 point

High respiratory rate (greater or equal to 22 breaths per minute): 1 point

Altered mentation (GCS<15): 1 point

The score ranges from 0 to 3 points. The presence of 2 or more qSOFA points near the onset of infection was associated with a greater risk of death or prolonged intensive care unit stay.

Reference:

Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41:580-637.

The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Mervyn Singer, MD et al. JAMA February 23, 2016 Volume 315, Number 8.

Answer Statistics

1

7%

2

13%

3

67%

4

5%

5

10%

Times answered: 284