Prognostic categorization of intensive care septic patients

Table 1 Mortality in various degrees of severity of sepsis

Diagnosis	Number (1100)	Deaths (%)
Nil	421	101 (24.0)
SIRS	573	152 (26.5)
Sepsis	50	18 (36.0)
Severe sepsis	23	12 (52.2)
Septic shock	33	27 (81.8)

SIRS: Systemic inflammatory response syndrome.

Table 2 Multiple organ dysfunction score

Organ system	Score
	0	1	2	3	4
Respiratory PaO2/FiO2	> 300	226-300	151-225	76-150	≤ 75
Renal creatinine (μmol/L)	≤ 100	101-200	201-350	251-500	> 500
Hepatic bilirubin (μmol/L)	≤ 20	21-60	61-120	121-240	> 240
Cardiovascular PAR1	< 10.0	10.1-15	15.1-20	20.1-30	> 30.0
Cardiovascular HR (beats/min)	< 120	120-140	> 140	Dopamine > 3 mg/g per min	Lactate > 5 mmoL/L
Hematologic platelet count (/L)	> 120	81-120	51-80	21-50	≤ 20
Neurologic Glasgow coma score	15	13-14	10-12	7-9	≤ 6

¹Pressure-adjusted heart rate (PAR): Product of the heart rate multiplied by the ratio of the right atrial pressure to the mean arterial pressure.

Table 3 Sequential organ failure assessment score

Organ system	Score
	0	1	2	3	4
Respiratory PaO2/FiO2	> 400	≤ 400	≤ 300	≤ 200	≤ 100
Renal creatinine (μmol/L)	≤ 110	110-170	171-299	300-440 urine output ≤ 500 mL/d	> 440 urine output < 200 mL/d
Hepatic bilirubin (μmol/L)	≤ 20	20-32	33-101	102-204	> 240
Cardiovascular hypotension	No hypotension	MAP < 70 mmHg	Dopamine ≤ 51	Dopamine > 51 or epinephrine ≤ 0.11 or norepinephrine ≤ 0.11	Dopamine > 151 or epinephrine > 0.11 or norepinephrine > 0.11
			Dobutamine (any dose)
Hemotologic platelet count (/mL)	> 150	≤ 150	≤ 100	≤ 50	≤ 20
Neurologic Glasgow coma score	15	13-14	10-12	6-9	< 6

¹Adrenergic agents administered for at least 1 h (doses given are in μg/kg per minute).

Table 4 Logistic organ dysfunction score

Organ system	LOD points
	Increasing severity/decreasing values			Organ dysfunction free		Increasing severity/increasing values
	5	3	1	0	1	3	5
Neurologic Glasgow coma score	3-5	6-8	9-13	14-15
Cardiovascular heart rate (min)	< 30 or < 40	40-69	70-89	30-139	≥ 140 or 240-269
Systolic blood pressure (mmHg)				90-239		≥ 270
Renal
Serum urea (g/L)				< 6	6-9.9	10-19.9	≥ 20
Serum urea nitrogen (mmol)				< 6	6-9.9 or 106-140	10-19.9 or ≥ 141 or ≥ 10	≥ 20
Creatinine (μmol)				< 106
Urine output (I/d)	< 0.5	0.5-0.74		0.75-9.99
Pulmonary PaO2/FiO2 on MV or CPAP PaO2 (kPa)/FiO2		< 150 (< 19.9)	≥ 150 (≥ 19.9)	No ventilation, no IPAP or no CPAP
Hematologic
White blood cell count (× 109/L)		< 1.0	1.0-2.4 or < 50	2.5-49.9	≥ 50.0
Plateltes (× 109/L)				≥ 50
Hepatic bilirubin (μmol/L)				< 34.2	≥ 34.2
Prothrombin time, seconds above standard (% of standard)			(< 2.5%)	≤ 3 (≥ 25%)	> 3

IPAP: Inspiratory positive airway pressure; CPAP: Continuous positive airway pressure; LOD: Logistic organ dysfunction.

Table 5 Acute physiology score in Acute Physiology and Chronic Health Evaluation II

Physiological variable	High abnormal range					Low abnormal range
	4	3	2	1	0	1	2	3	4
Temperature-rectal (°C )	≥ 41	39-40.9		38.5-38.9	36-38.4	34-35.9	32-33.9	30-31.9	≤ 29.9
Mean arterial pressure (mmHg)	≥ 160	130-159	110-129		70-109		50-69		≤ 49
Heart rate (ventricular response)	≥ 180	140-179	110-139		70-109		50-69	40-54	≤ 39
Respiratory rate (non-ventilated or ventilated)	≥ 50	35-49		25-34	12-24	10-11	6-9		≤ 5
Oxygenation
A-a DO2 (mmHg)
FiO2≥ 0.5	≥ 500	350-499	200-349		< 200
Record
A-a DO2 (mmHg)
FiO2 < 0.5 record only PaO2					PO2 > 70	PO2 (6-70)		PO2 (55-60)	PO2 < 55
Arterial pH	≥ 7.7	7.6-7.69		7.5-7.59	7.33-7.49		7.25-7.32	7.15-7.24	< 7.15
Serum sodium (mmol/L)	≥ 180	160-179	155-159	150-154	130-149		120-129	111-119	< 7.15
Serum potassium (mmol/L)	≥ 7	6-6.9		5.5-5.9	3.5-5.4	3-3.4	2.5-2.9		< 2.5
Serum creatinine (10 mg/L) (double point score for acute renal failure)	≥ 3.5	2-3.4	1.5-1.9		0.6-1.4		< 0.6
Hematocrit (%)	≥ 60		50-59.9	46-49.9	30-45.9		20-29.9		< 20
White blood count (total/mm3) (in 1000)	≥ 40		20-39.9	15-19.9	3-14.9		1-2.9		< 1
GCS: score = 15 minus actual GCS
Total APS: Sum of the 12 individual variable points
Serum HCO3 (venous-mmol/L) (not preferred, use if no ABG)	≥ 52	41-51.9		32-40.9	22-31.9		18-21.9	15-17.9	< 15

GCS: Glasgow coma score; APS: Acute physiology score .

Table 6 Acute physiology score in Acute Physiology and Chronic Health Evaluation III scoring system

Parameter	Value range	Points	Parameter	Value range	Points
Core temperature (°C)	0-32.9	20	Plasma bilirubin (μmol/L)	0-34	0
	33.0-33.4	16		35-51	5
	33.5-33.9	13		52-85	6
	34.0-34.9	8		86-135	8
	35.0-35.9	2		136 plus	16
	36.0-36.9	0
	40 or more	4
Heart (r/min)	0-39	8	Urine volume (mL/24 h)	0-399	15
	40-49	5		400-599	3
	50-99	0		600-899	7
	100-109	1		900-1499	5
	110-119	5		1500-1999	4
	120-139	7		2000-3999	0
	140-154	13		4000 plus	1
	155 or more	17
Mean blood pressure (mmHg)	0-39	23	Plasma Creatinine (μmol/L) (if no acute renal failure) or in ARF (< 410 mL urine vol/24 h)	0-43	3
	40-59	15		44-132	0
	60-69	7		133-171	2
	70-79	6		172 or more	7
	80-99	0
	100-119	4
	120-129	7		0-132	0
	130-139	9		133 or more	10
	140 or more	10
Respiratory (r/min) (zero points for 6-12/min rate if on ventilation)	0-5	17	Arterial PO2 (kPa) (Inspired O2 < 50%) or alveolar/arterial PO2 difference kPa (Pa-PaO2) (Inspired O2 > 50%)	0-6.66	15
	6-11	8		6.67-9.32	5
	12-13	7		9.33-10.6	2
	14-24	0		10.7 plus	0
	25-34	6
	35-39	9		0-13.2	0
	40-49	11		13.3-33.2	7
	50 or more	18		33.3-46.5	9
				46.6-66.6	11
				66.7 and over	14
White cell count (× 109/L)	0-0.9	19	Age (yr)	0-44	0
	1.0-2.9	5		45-59	5
	3.0-19.9	0		60-64	11
	20.0-24.9	1		65-69	13
	25 or more	4		70-74	17
				75 or more	24
Haematocrit (%)	0-49.9	0	Chronic health evaluation (do not score in elective surgery patients)	Cirrhosis Immunosuppression Leukaemia Multiple myeloma	4
	50 or more	3			10
					10
					10
Plasma sodium (mmol/L)	0-119	3		Metastaic cancer	11
	120-134	2		Lymphoma	13
	135-154	0		Hepatic failure	16
	155 or more	4		AIDS	23
Plasma albumin (g/L)	0-19	11	Neurological score	Use matrix	0-48
	20-44	0
	45 or more	4
Acid base status	Use matrix	0-12