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SIRS & Sepsis Criteria
Defines the severity of sepsis and septic shock. Used to screen and guide early, aggressive resuscitative measures. For patients ≥18 years.
SIRS Criteria (Systemic Inflammatory Response Syndrome)
Temperature
>38°C (100.4°F) OR <36°C (96.8°F)
Heart Rate
>90 beats per minute
Respiratory Rate or PaCO₂
RR >20 breaths/min OR PaCO₂ <32 mm Hg
White Blood Cell Count (WBC)
>12,000/mm³, <4,000/mm³, OR >10% bands
Sepsis & Shock Progression
Suspected Source of Infection
Is there a suspected or present source of infection?
Organ Dysfunction / Hypoperfusion
Lactic acidosis, SBP <90, or SBP drop ≥40 mm Hg of normal
Refractory Hypotension
Hypotension present despite adequate fluid resuscitation
Multiple Organ Dysfunction (MODS)
Evidence of ≥2 organs failing
0
SIRS
Criteria Met
Criteria Met
Evaluating…
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MODS Criteria Met
| Diagnosis | Criteria Requirements |
|---|---|
| Normal / Excluded | 0-1 SIRS criteria met. |
| SIRS | ≥ 2 SIRS criteria met. Screen for infection. |
| Sepsis | SIRS + Suspected source of infection. |
| Severe Sepsis | Sepsis + Organ dysfunction / Hypoperfusion. |
| Septic Shock | Severe Sepsis + Hypotension despite fluid resuscitation. |
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Lactate Driven Care: Screen for severe sepsis by obtaining a lactate level. A lactate ≥2 mmol/L is considered elevated. Aggressive management with broad-spectrum antibiotics and IVF should be considered.
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Time is Critical: The Surviving Sepsis Campaign Guidelines recommend initiation of antimicrobials within 1 hour from the time of recognition of severe sepsis/septic shock, or within 3 hours of arrival.
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Clinical Judgment: A significant number of patients (e.g., young, healthy viral illnesses) may meet criteria for SIRS or Sepsis but may not require aggressive interventions if well-appearing. Do not rely solely on scores.
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Hemodynamic Instability: If a patient has suspected infection AND hemodynamic instability, treat immediately for septic shock. Do not delay management waiting for lab values (WBC, lactate).
