Sepsis natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

Synonyms and keywords: sepsis syndrome; septic shock; septicemia


There are many complications associated with sepsis, especially because it is a systemic phenomenon. Sepsis is a severe condition, and the prognosis of the patient will depend greatly on the condition and overall health of the patient. Many factors, such as age, hosts immune response, site of infection, type of infection, appropriate antibiotic therapy, and restoration of circulation of perfusion contribute to the overall prognosis.[1][2] [3][4][5][6] [7]

Natural History

If left untreated sepsis can lead to multiorgan failure and eventually death.



The serum lactate level may be more predictive of outcomes than the serum bicarbonate[8].


Mortality can be estimated with the MEDS (Mortality in Emergency Department Sepsis)score. More complicated scores such as the Apache, Sequential Organ Failure Assessment (SOFA), and Logistic Organ Dysfunction System (LODS) can be used as well.[4][5][6]

Mortality in Emergency Department Sepsis(MEDS) Point System[4]

The components and their scores for the MEDS are described in the following table

Component Points
Rapidly progressing terminal co-morbid illness 6
Age >65 3
Granulocytic bands are greater than 5% 3
If the patient has tachypnea or hypoxia 3
If the patient is in shock 3
If the patient has a platelet count of less than 150,000 mm3 3
Altered mental status 2
Resident of a nursing home 2
Lower respiratory infection 2

The total score will be added up and that total will correlate to the mortality percentage with a 95% confidence interval. The following are the point ranges associated with various mortality percentages.

  • 0-4 points total - 0.6% mortality rate
  • 5-7 points total - 5% mortality rate
  • 8-12 points total - 19% mortality rate
  • 13-15 points total - 32% mortality rate
  • 15+ points total - 40% mortality rate

The area under the receiver operating characteristic curve for the MEDs score is 0.92.[4]

Septic shock

Approximately 12% of of patients with sepsis progress to septic shock within 48 hours. Among variables studied (which did not include procalcitonin, predictors of progression to septic shock were:[3]

  • Nonpersistent hypotension
  • Bandemia at least 10%
  • Lactate at least 4.0 mmol/L
  • Past medical of coronary artery disease
  • Female gender


  1. 1.0 1.1 Kellum JA, Chawla LS, Keener C, Singbartl K, Palevsky PM, Pike FL; et al. (2016). "The Effects of Alternative Resuscitation Strategies on Acute Kidney Injury in Patients with Septic Shock". Am J Respir Crit Care Med. 193 (3): 281–7. doi:10.1164/rccm.201505-0995OC. PMC 4803059. PMID 26398704.
  2. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R (2015). "Systemic Inflammatory Response Syndrome Criteria in Defining Severe Sepsis". N Engl J Med. doi:10.1056/NEJMoa1415236. PMID 25776936.
  3. 3.0 3.1 Capp R, Horton CL, Takhar SS, Ginde AA, Peak DA, Zane R; et al. (2015). "Predictors of Patients Who Present to the Emergency Department With Sepsis and Progress to Septic Shock Between 4 and 48 Hours of Emergency Department Arrival". Crit Care Med. doi:10.1097/CCM.0000000000000861. PMID 25668750.
  4. 4.0 4.1 4.2 4.3 Williams JM, Greenslade JH, Chu K, Brown AF, Lipman J (2016). "Severity Scores in Emergency Department Patients With Presumed Infection: A Prospective Validation Study". Crit Care Med. 44 (3): 539–47. doi:10.1097/CCM.0000000000001427. PMID 26901543.
  5. 5.0 5.1 Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW (2003). "Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule". Crit. Care Med. 31 (3): 670–5. doi:10.1097/01.CCM.0000054867.01688.D1. PMID 12626967.
  6. 6.0 6.1 Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A; et al. (2016). "Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)". JAMA. 315 (8): 762–74. doi:10.1001/jama.2016.0288. PMID 26903335.
  7. GitHub Contributors. Prognosticating in sepsis with decision aids: a living systematic review. GitHub. Available at Accessed January 26, 2017.
  8. Meregalli A, Oliveira RP, Friedman G (2004). "Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients". Crit Care. 8 (2): R60–5. doi:10.1186/cc2423. PMC 420024. PMID 15025779.

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