Which lab test findings suggest an underlying etiology of bacterial sepsis?

Updated: Feb 05, 2019
  • Author: Amber Mahmood Bokhari, MBBS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Laboratory and clinical features that may suggest an underlying etiology of sepsis are as follows:

  • Leukocytosis (WBC count >12,000/µL) or leukopenia (WBC count < 4000/µL)
  • Normal WBC count with greater than 10% immature forms (left shift with bandemia)
  • Hyperglycemia (plasma glucose level >140 mg/dL or 7.7 mmol/L) in the absence of diabetes [23]
  • Plasma C-reactive protein level of more than two standard deviations above the reference value
  • Arterial hypoxemia (PaO 2/FiO 2 ratio < 300 mm Hg)
  • Acute oliguria (urine output < 0.5 mL/kg/hour for at least 2 hours despite adequate fluid resuscitation)
  • Creatinine increase >0.5 mg/dL or 44.2 mmol/L
  • Coagulation abnormalities (INR >1.5 or PTT >60 seconds)
  • Thrombocytopenia (platelet count < 100,000/µL) [22]
  • Hyperbilirubinemia (plasma total bilirubin >4 mg/dL or 70 mmol/L)
  • Adrenal insufficiency (eg, hyponatremia, hyperkalemia) and euthyroid sick syndrome can also be found in sepsis.
  • Hyperlactatemia (serum lactate >2 mmol/L) can result from organ hypoperfusion in the presence or absence of hypotension and indicates a poor prognosis. A serum lactate level of 4 mmol/L or more (especially arterial lactate) indicates septic shock.
  • Plasma procalcitonin and presepsin elevation is associated with bacterial infection and sepsis. [5, 6, 7, 8]

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