In 1991 a consensus conference produced definitions of sepsis and its adverse sequelae. The term systemic inflammatory

Table 7.1 Mortality rates in the sepsis continuum (mortality also increases with age)

Diagnosis Mortality (%)

Bacteraemia 10-20

Bacteraemia + sepsis 20-30

Severe sepsis 40-60

Sepsis + multiple organ failure over 80

Figure 7.1 Systemic inflammatory response syndrome and sepsis

response syndrome (SIRS) defines the clinical manifestations of the widespread inflammation that results from a variety of insults including infection, pancreatitis, burns, and trauma including surgery (Figure 7.1). Sepsis is defined as the systemic inflammatory response to a documented infection. Severe sepsis is associated with organ dysfunction and hypoperfusion. Septic shock refers to those patients who remain hypotensive despite adequate fluid resuscitation. Box 7.1 shows the definitions in the sepsis continuum.

The term multiple organ dysfunction syndrome (MODS) is a clinical syndrome in which the development of progressive and potentially reversible physiological dysfunction in two or more organ systems occurs. It is induced by a variety of acute insults and its occurrence in sepsis is characteristic. MODS is a continuum - varying from a mild degree of dysfunction to frank organ failure.

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