Which clinical characteristics are associated with the severity of sepsis and mortality?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Mortality has been found to vary according to the degree of illness, which may range along a spectrum extending from sepsis to septic shock. The following clinical characteristics are related to the severity of sepsis:

  • Abnormal host response to infection

  • Site and type of infection

  • Timing and type of antimicrobial therapy

  • Offending organism

  • Development of shock

  • Any underlying disease

  • Patient’s long-term health condition

  • Location of the patient at the time of septic shock onset

  • Host immunogenetic variation

Factors consistently associated with increased mortality in sepsis include advanced age, comorbid conditions, and clinical evidence of organ dysfunction. [40, 45] One study found that in the setting of suspected infection, simply meeting SIRS criteria, without evidence of organ dysfunction, did not predict increased mortality; this finding suggests that organ dysfunction is a better predictor than SIRS criteria alone. [45] However, there is evidence that meeting greater numbers of SIRS criteria is associated with increased mortality. [48]

Notably, tachypnea is the SIRS criterion that best predicts an adverse outcome. This is likely because tachypnea is also an indicator of pulmonary organ dysfunction and a feature commonly associated with pneumonia and ARDS, both of which are associated with increased mortality in sepsis. Altered mental status is considered a sign of organ dysfunction and is also associated with increased mortality.


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