![]() The American College of Chest Physicians/Society of Critical Care Medicine-sponsored sepsis definitions consensus conference held in Chicago, Illinois in August 1991 aimed to establish a standard group of clinical parameters to identify those subjects in any clinical setting easily. Identifying the subjects at any setting with easy-to-use standardized parameters, therefore, held the key. An early, time-sensitive approach to diagnosis and intervention is necessary to impact patient survival and morbidity significantly. With the advent of new concepts in pathophysiology and therapeutic interventions for sepsis in the early 90s, there was an increasing need to identify a homogenous group of potential subjects for clinical trials investigating new innovative therapeutic strategies. Borne out of the plethora of emerging studies, one opinion was unanimous. The Acute Physiology and Chronic Health Evaluation (APACHE) score version II and III, Multiple organ dysfunction (MOD) score, sequential organ failure assessment (SOFA), and logistic organ dysfunction (LOD) score are to name a few. Several scores exist to assess the severity of organ system damage. Establishing laboratory indices to identify such subgroups of patients and the clinical criteria that we currently rely upon has been gaining prominence over recent years. explained exceptions to this theory by suggesting that there are subgroups of hospitalized patients, particularly at extremes of age, who do not meet the criteria for SIRS on presentation but progress to severe infection and multiple organ dysfunction and death. To summarize, almost all septic patients have SIRS, but not all SIRS patients are septic. ![]() In the pediatric population, the definition is modified to a mandatory requirement of abnormal leukocyte count or temperature to establish the diagnosis, as abnormal heart rate and respiratory rates are more common in children. Leukocyte count greater than 12000 or less than 4000 /microliters or over 10% immature forms or bands. Objectively, SIRS is defined by the satisfaction of any two of the criteria below: ![]() The American College of Chest Physicians/Society of Critical Care Medicine-sponsored sepsis definitions consensus conference also identified the entity of m ultiple organ dysfunction syndrome (MODS) as the presence of altered organ function in acutely ill septic patients such that homeostasis is not maintainable without intervention. Together they represent a physiologic continuum with progressively worsening balance between pro and anti-inflammatory responses of the body. Sepsis with one or more end-organ failures is called severe sepsis, and hemodynamic instability despite intravascular volume repletion is called septic shock. Confirmation of infection with positive cultures is therefore not mandatory, at least in the early stages. SIRS with a suspected source of infection is termed sepsis. Even though the purpose is defensive, the dysregulated cytokine storm can cause a massive inflammatory cascade leading to reversible or irreversible end-organ dysfunction and even death. It involves the release of acute-phase reactants, which are direct mediators of widespread autonomic, endocrine, hematological, and immunological alteration in the subject. Systemic inflammatory response syndrome (SIRS) is an exaggerated defense response of the body to a noxious stressor (infection, trauma, surgery, acute inflammation, ischemia or reperfusion, or malignancy, to name a few) to localize and then eliminate the endogenous or exogenous source of the insult.
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