Sepsis and Septic Shock Scoring Systems

Monitoring and Prognostication

• Different scoring systems are available for predicting sepsis and septic shock outcomes, but none of them were developed to guide septic shock management.
• The Sequential Organ Failure Assessment (SOFA) score is the most commonly used and endorsed scoring system.
• SOFA is a dynamic score that gets higher quickly but decreases slowly, and all its points are severity-based.
• Plasmatic procalcitonin and CRP have similar results to the SOFA score in terms of prognosis, and their values should be serial to trend the situation.
• A comprehensive trend of all parameters, including SOFA, plasmatic procalcitonin, and plasmatic CRP, must be taken into consideration to determine if the patient is improving or relapsing.

Tissue Perfusion

• Lactate is often used to indirectly monitor tissue perfusion, but it is only one of the parameters to monitor tissue perfusion.
• The initial lactate level is a powerful predictive factor of outcome in sepsis, but a decreasing lactate clearance after resuscitation to persistently high blood lactate levels is associated with a significantly worse outcome.
• Biomarkers, such as pro-adrenomedullin and copeptin, follow endothelial cells' involvement during septic shock and have shown promising results.

Biomarkers

• Procalcitonin (PCT) significantly increases in the subgroups of septic shock and bacteremia, and negatively correlates with the PaO2/FiO2 ratio at admission and during the first hours in the emergency department.
• PCT could be used as an indicator of progression of septic shock in the early phase and might be exploited for clinical decision-making.
• Serial measurement of biomarkers in the blood has been widely used for monitoring and prognostication in septic shock.

Scoring Systems

• The Sequential Organ Failure Assessment (SOFA) score is perhaps the most recommended scoring system for use in septic shock.
• SOFA scores 13 different parameters and is based on the derangement of the parameters outside a given reference range.
• The SOFA score strongly correlates with mortality in the intensive care unit and is used in research and clinical prognostication.

Monitoring and Prognostication

• Different scoring systems are available for predicting sepsis and septic shock outcomes, but none of them were developed to guide septic shock management.
• The Sequential Organ Failure Assessment (SOFA) score is the most commonly used and endorsed scoring system.
• SOFA is a dynamic score that gets higher quickly but decreases slowly, and all its points are severity-based.
• Plasmatic procalcitonin and CRP have similar results to the SOFA score in terms of prognosis, and their values should be serial to trend the situation.
• A comprehensive trend of all parameters, including SOFA, plasmatic procalcitonin, and plasmatic CRP, must be taken into consideration to determine if the patient is improving or relapsing.

Tissue Perfusion

• Lactate is often used to indirectly monitor tissue perfusion, but it is only one of the parameters to monitor tissue perfusion.
• The initial lactate level is a powerful predictive factor of outcome in sepsis, but a decreasing lactate clearance after resuscitation to persistently high blood lactate levels is associated with a significantly worse outcome.
• Biomarkers, such as pro-adrenomedullin and copeptin, follow endothelial cells' involvement during septic shock and have shown promising results.

Biomarkers

• Procalcitonin (PCT) significantly increases in the subgroups of septic shock and bacteremia, and negatively correlates with the PaO2/FiO2 ratio at admission and during the first hours in the emergency department.
• PCT could be used as an indicator of progression of septic shock in the early phase and might be exploited for clinical decision-making.
• Serial measurement of biomarkers in the blood has been widely used for monitoring and prognostication in septic shock.

Scoring Systems

• The Sequential Organ Failure Assessment (SOFA) score is perhaps the most recommended scoring system for use in septic shock.
• SOFA scores 13 different parameters and is based on the derangement of the parameters outside a given reference range.
• The SOFA score strongly correlates with mortality in the intensive care unit and is used in research and clinical prognostication.