Editing Sepsis (section)

=== Definitions ===
{{SIRS}}
[[File:Sepsis Steps.png|thumb|upright=1.25|Sepsis Steps. Training tool for teaching the progression of sepsis stages]]
Previously, SIRS criteria had been used to define sepsis. If the SIRS criteria are negative, it is very unlikely the person has sepsis; if it is positive, there is just a moderate probability that the person has sepsis. According to SIRS, there were different levels of sepsis: sepsis, severe sepsis, and septic shock.<ref name="1992consensus"/> The definition of SIRS is shown below:
* SIRS is the presence of two or more of the following: abnormal [[body temperature]], [[heart rate]], [[respiratory rate]], or [[blood gas]], and [[white blood cell]] count.
* ''Sepsis'' is defined as SIRS in response to an infectious process.<ref name=Soong2012/>
* ''Severe sepsis'' is defined as sepsis with sepsis-induced organ dysfunction or tissue hypoperfusion (manifesting as hypotension, elevated lactate, or [[oliguria|decreased urine output]]). Severe sepsis is an infectious disease state associated with multiple organ dysfunction syndrome (MODS)<ref name=SSCG2012/>
* ''[[Septic shock]]'' is severe sepsis plus persistently [[hypotension|low blood pressure]], despite the administration of intravenous fluids.<ref name=SSCG2012/>

In 2016 a new consensus was reached to replace screening by [[systemic inflammatory response syndrome]] (SIRS) with the sequential organ failure assessment ([[SOFA score]]) and the abbreviated version ([[qSOFA]]).<ref name="Sepsis–3_2016"/> The three criteria for the qSOFA score include a respiratory rate greater than or equal to 22 breaths per minute, systolic blood pressure 100 mmHg or less, and altered mental status.<ref name="Sepsis–3_2016" /> Sepsis is suspected when 2 of the qSOFA criteria are met.<ref name="Sepsis–3_2016" /> The SOFA score was intended to be used in the intensive care unit (ICU) where it is administered upon admission to the ICU and then repeated every 48 hours, whereas the qSOFA could be used outside the ICU.<ref name="Gauer et al">{{cite journal | vauthors = Gauer RL | title = Early recognition and management of sepsis in adults: the first six hours | journal = American Family Physician | volume = 88 | issue = 1 | pages = 44–53 | date = July 2013 | pmid = 23939605 }}</ref> Some advantages of the qSOFA score are that it can be administered quickly and does not require labs.<ref name="Gauer et al" /> However, the [[American College of Chest Physicians]] (CHEST) raised concerns that qSOFA and SOFA criteria may lead to delayed diagnosis of serious infection, leading to delayed treatment.<ref name=Simpson2016/> Although SIRS criteria can be too sensitive and not specific enough in identifying sepsis, SOFA also has its limitations and is not intended to replace the SIRS definition.<ref name=Vincent2016/> qSOFA has also been found to be poorly sensitive though decently specific for the risk of death with SIRS possibly better for screening. NOTE - Surviving Sepsis Campaign 2021 Guidelines recommend "against using qSOFA compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock".<ref name=Fernando2018/>