Definitions

Being a syndrome ('a set of signs and symptoms') with an important interindividual variation, the decision as to who should be identified as a 'septic patient' relies on the presence of a sufficient number of preset symptoms, which may be attributed a weight factor. Especially since no single sign or symptom is explicitly required, it is not difficult to conceive that the great differences observed in epidemiology, outcome, efficacy of interventions and presence of mediators between the distinct clinical studies might be more a result from different definitions than from anything else.

Recently, an American College of Chest Physicians/Society of Care Medicine (ACCP/SCCM) consensus conference has proposed a new set of definitions of sepsis and related disorders that is becoming more and more accepted by the scientific community. 'Sepsis' is defined as a systemic inflammatory response to an infection. When sepsis is associated with organ dysfunction, hypoperfusion or hypotension, it is termed 'severe sepsis'. When the hypotension induced by sepsis persists despite adequate fluid resuscitation, in the presence of perfusion abnormalities, the term 'septic shock' is adequate. The recommendations of this conference and the interrelationship of the distinct entities are shown in Table 1 and Figure 1, respectively.

Since sepsis and related disorders may present themselves in an important variation of severity, a severity-of-illness scoring system is an essential part of the description of patient populations. APACHE (Acute Physiology and Chronic Health Fvaluation) scores are the most widely used severity scores, but a number of other scores exist.

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