The clinical features of septicemia intensify over time from mild to severe.

The cardinal symptoms of sepsis include:

• Fever, chills or hypothermia
• Hypotension and oliguria
• Hyperventilation
• Mental status changes
• Skin manifestations

These features may be preceded by lethargy, headache and minor changes in consciousness.

In the elderly and immunocompromised patients, the clinical features may be quite subtle.

• Fever

  A 32-year-old female presented with fever and generalised malaise to a rural hospital in Ghana. The patient had previously been diagnosed as having enteric fever from a neighbouring health facility. [ncbi.nlm.nih.gov]

  It is also important to recognize that the effect of fever control on outcomes may be dependent on whether the fever is due to an infectious etiology or not [ 5, 6 ]. [doi.org]

• Weakness

  Overall, 32 were strong recommendations, 39 were weak recommendations, and 18 were best-practice statements. No recommendation was provided for four questions. [ncbi.nlm.nih.gov]

  Weak recommendations use "consider" or "suggested" phrasing. Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. [dynamed.com]

  You may also have: Confusion and weakness Skin that's hot to the touch A fast, pounding pulse Fast breathing or trouble breathing Less urine Some people with septic shock will die from it. At first, sepsis can be hard to diagnose. [msdmanuals.com]

• Chills

  CASE SUMMARY: A 55-year-old woman underwent surgery for lumbar spinal stenosis and developed high fever (39.5°C) after surgery, accompanied by chills and fatigue. [ncbi.nlm.nih.gov]

  Common symptoms of sepsis are fever, chills, rapid breathing and heart rate, rash, confusion and disorientation. [cottagehealth.org]

  “Chills are subjective—a patient feels chills but it cannot be observed by a health-care provider,” Dr. Dellinger says. [rd.com]

  Chills and shivering, A sped-up heartbeat Fast breathing In some cases, symptoms of more severe sepsis or septic shock - when blood pressure drops to a dangerously low level - develop soon after. [mirror.co.uk]

  […] with weakened immune systems Infants and children Adults 65 and older People with chronic illnesses, such as diabetes, AIDS, cancer, and kidney or liver disease People suffering from a severe burn or physical trauma Common symptoms of sepsis are fever, chills [nlm.nih.gov]

• Multiple Organ Dysfunction Syndrome

  Up to now, sepsis still remains a dominant cause of multiple organ dysfunction syndrome (MODS) and death among severe condition patients. [ncbi.nlm.nih.gov]

  Definitions for severe sepsis, septic shock, hypotension, and multiple organ dysfunction syndrome were also offered. The use of severity scoring methods were recommended when dealing with septic patients as an adjunctive tool to assess mortality. [doi.org]

• Hypothermia

  Abstract Sepsis is the systemic response to infection manifested as hyperthermia or hypothermia, tachycardia, tachypnea, and shock. This condition represents a major life-threatening factor in all age groups, particularly in neonatal period. [ncbi.nlm.nih.gov]

  Hypothermia is associated with adverse outcome in patients admitted to ICUs and increases the risk for nosocomial infection [ 8, 18 ]. [doi.org]

  This response includes an abnormally high temperature ( fever ) or low temperature ( hypothermia ) plus one or more of the following: Rapid heart rate Rapid breathing rate Although many infections cause such symptoms throughout the body, in sepsis organs [merckmanuals.com]

  The most prominent are: Decreased urine output Fast heart rate Fever Hypothermia (very low body temperature) Shaking Chills Warm skin or a skin rash Confusion or delirium Hyperventilation (rapid breathing) Cleveland Clinic News & More Cleveland Clinic [my.clevelandclinic.org]

  In general, symptoms of sepsis can include: Chills Confusion or delirium Fever or low body temperature ( hypothermia ) Lightheadedness due to low blood pressure Rapid heartbeat Skin rash or mottled skin Warm skin A person with sepsis will be admitted [nlm.nih.gov]

• Respiratory Distress

  PATIENT CONCERNS: A healthy 3-year-old girl admitted to the Pediatric Emergency Department presented a sepsis-associated purpura with neurological and respiratory distress. [ncbi.nlm.nih.gov]

• Tachypnea

  The infant was managed with respiratory support and gradually infant improved and diagnosis of transient tachypnea of newborn was made. [ncbi.nlm.nih.gov]

  Tachycardia and tachypnea are extremely common in mild pediatric illness; these are not as useful in selecting for septic patients. Therefore either a temperature or leukocyte abnormality must be present to meet pediatric SIRS criteria. [mdcalc.com]

  Organ dysfunction is determined using a sequential organ failure assessment (SOFA) score that considers multiple parameters, but may be quickly evaluated and assumed if two of the following findings are present: tachypnea, hypotension, and altered mental [amboss.com]

  […] mentation [derived from Glasgow Coma Score <13]) while SIRS (including tachycardia >90 and tachypnea >20) criteria is deleted. [medintensiva.org]

• Dyspnea

  Respiratory infection Cough, chest pain, and dyspnea may suggest pneumonia or empyema but may also be observed in patients with pulmonary embolism or pleural effusion. [emedicine.medscape.com]

  Organ dysfunction causes additional symptoms and signs specific to the organ involved (eg, oliguria, dyspnea). [merckmanuals.com]

• Vomiting

  We report a case of Escherichia coli SICM in a 63-year-old woman presented with sudden onset of dyspnoea on exertion and orthopnoea following nausea, vomiting and diarrhoea after consuming Chinese foods. [ncbi.nlm.nih.gov]

  The first symptoms of meningitis are often fever, vomiting, headache and feeling unwell. Septic shock In some cases, symptoms of more severe sepsis or septic shock (when your blood pressure drops to a dangerously low level) develop soon after. [nhs.uk]

  Other common clinical features at this stage include: Shivering Disorientation Lightheadedness Nausea and vomiting 2. [news-medical.net]

• Diarrhea

  Congenital tufting enteropathy (CTE) is characterized by the early-onset of chronic diarrhea and the inability to develop. It is a rare congenital disease with a low prevalence of 1:50,000 - 100,000 live births p.a. [ncbi.nlm.nih.gov]

  If people with bacteremia have fever, a rapid heart rate, shaking chills, low blood pressure, gastrointestinal symptoms (such as abdominal pain, nausea, vomiting, and diarrhea), rapid breathing, and/or become confused, they probably have sepsis or septic [merckmanuals.com]

  Other common warning signs include: Fever and chills Very low body temperature Peeing less than normal Rapid pulse Rapid breathing Nausea and vomiting Diarrhea Continued Sepsis Treatment If your doctor believes you might have sepsis, he’ll do an exam [webmd.com]

  Updates Commentary: The economic burden of pneumonia, diarrhea, and measles is significant for households in Uganda December 2018 The Decade of Vaccine Economics (DOVE) study has revealed significant household costs associated with childhood diseases [jhsph.edu]

• Nausea

  We report a case of Escherichia coli SICM in a 63-year-old woman presented with sudden onset of dyspnoea on exertion and orthopnoea following nausea, vomiting and diarrhoea after consuming Chinese foods. [ncbi.nlm.nih.gov]

  People with suspected sepsis can show: · low blood pressure · high temperature (fever) or low temperature · fast heartbeat · breathlessness · feeling weak or loss of consciousness · being confused or disorientated · loss of appetite · diarrhoea, nausea [nice.org.uk]

  If people with bacteremia have fever, a rapid heart rate, shaking chills, low blood pressure, gastrointestinal symptoms (such as abdominal pain, nausea, vomiting, and diarrhea), rapid breathing, and/or become confused, they probably have sepsis or septic [merckmanuals.com]

• Abdominal Pain

  Two weeks after his discharge, he presented with severe abdominal pain, fever, and vomiting. Radiologic assessment showed pneumoperitoneum. Urgent exploratory laparotomy revealed significant amount of gas and no bowel perforation. [ncbi.nlm.nih.gov]

  If people with bacteremia have fever, a rapid heart rate, shaking chills, low blood pressure, gastrointestinal symptoms (such as abdominal pain, nausea, vomiting, and diarrhea), rapid breathing, and/or become confused, they probably have sepsis or septic [merckmanuals.com]

  Organ dysfunction is characterized by symptoms such as decreased urine output, sudden changes in mental state, decreased blood platelet count, difficulty breathing, abnormal heart pumping function and abdominal pain. [news-medical.net]

  pain Septic shock To be diagnosed with septic shock, you must have the signs and symptoms of severe sepsis—plus extremely low blood pressure that doesn’t adequately respond to simple fluid replacement. [aft.org]

  So, for example, a patient who's breathing rapidly, having difficulty breathing could have damaged lung tissue, or a patient with severe abdominal pain might have a bowel perforation, or intestinal issues. [khanacademy.org]

• Hypotension

  Administration of 30 ml/kg IV crystalloid for hypotension or lactate ≥ 4 mmol/L. [cdemcurriculum.com]

  In severe sepsis, resuscitation is performed during the first six hours to enhance the heart function in order to correct hypoxia, hypotension and hypoperfusion. [symptoma.com]

  Septic shock is defined as hypotension with a mean arterial pressure less than 65 mm Hg, requiring vasopressors despite adequate fluid resuscitation and/or lactic acid levels above 2 mmol/L. [ncbi.nlm.nih.gov]

  Abstract Purpose of review Norepinephrine is the first-line agent recommended during resuscitation of septic shock to correct hypotension due to depressed vascular tone. [doi.org]

  […] levels ≤ 2 mmol/L hypotension after fluids and no vasopressors and serum lactate levels > 2 mmol/L serum lactate levels > 2 mmol/L and no hypotension after fluids and no vasopressors serum lactate levels between 2-4 mmol/L and no hypotension before fluids [dynamed.com]

• Tachycardia

  tachycardia, Paroxysmal tachycardia, Junctional ectopic tachycardia, Sinus tachycardia, Atrial tachycardia, AV nodal reentrant tachycardia Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate.[1] In general, [en.wikipedia.org]

  Abstract Sepsis is the systemic response to infection manifested as hyperthermia or hypothermia, tachycardia, tachypnea, and shock. This condition represents a major life-threatening factor in all age groups, particularly in neonatal period. [ncbi.nlm.nih.gov]

  Tachycardia and tachypnea are extremely common in mild pediatric illness; these are not as useful in selecting for septic patients. Therefore either a temperature or leukocyte abnormality must be present to meet pediatric SIRS criteria. [mdcalc.com]

• Palpitations

  […] surgery or dental work those working in an environment with great exposure to bacteria or viruses, such as in a hospital or outdoors The symptoms of blood poisoning include: chills moderate or high fever weakness rapid breathing increased heart rate or palpitations [healthline.com]

  Tachycardia Other names Tachyarrhythmia ECG showing sinus tachycardia with a rate of about 100 beats per minute Pronunciation Tachycardia, tachyarrhythmia Specialty Cardiology Differential diagnosis Palpitations, Ventricular tachycardia, Supraventricular [en.wikipedia.org]

• Warm Skin

  The most prominent are: Decreased urine output Fast heart rate Fever Hypothermia (very low body temperature) Shaking Chills Warm skin or a skin rash Confusion or delirium Hyperventilation (rapid breathing) Cleveland Clinic News & More Cleveland Clinic [my.clevelandclinic.org]

  In general, symptoms of sepsis can include: Chills Confusion or delirium Fever or low body temperature ( hypothermia ) Lightheadedness due to low blood pressure Rapid heartbeat Skin rash or mottled skin Warm skin A person with sepsis will be admitted [nlm.nih.gov]

  Causes and Symptoms If you're experiencing symptoms of sepsis, which include fever, chills, mental confusion, rapid heartbeat, shaking, and warm skin, you should seek immediate medical help. [verywellhealth.com]

  In general, symptoms of sepsis can include: Chills Confusion or delirium Fever or low body temperature (hypothermia) Lightheadedness due to low blood pressure Rapid heartbeat Skin rash or mottled skin Warm skin Exams and Tests The health care provider [mountsinai.org]

• Eruptions

  And then it escalates, quickly erupting into widespread infection and inflammation that can cause organ failure and death if not treated fast enough. [statnews.com]

• Oliguria

  The cardinal symptoms of sepsis include: Fever, chills or hypothermia Hypotension and oliguria Hyperventilation Mental status changes Skin manifestations These features may be preceded by lethargy, headache and minor changes in consciousness. [symptoma.com]

  Organ dysfunction causes additional symptoms and signs specific to the organ involved (eg, oliguria, dyspnea). [merckmanuals.com]

  […] of the body, most readily seen in the fingers/arms, toes/legs Sepsis is diagnosed when there is an infection somewhere in the body AND one of the following: Organ dysfunction (organ failure) Hypoxemia (inability to circulate oxygen to your tissues) Oliguria [christopherreeve.org]

• Anuria

  Altered mental status, obtundation, restlessness Oliguria or anuria due to hypoperfusion Ileus or absent bowel sounds Special considerations Elderly patients may present with peritonitis and may not experience rebound tenderness of the abdomen. [37] Elderly [emedicine.medscape.com]

  The onset of oliguria (eg, < about 0.5 mL/kg/h) or anuria, or rising creatinine may signal impending renal failure. [merckmanuals.com]

  Included trials did not report changes in the glomerular filtration rates, incidence of renal recovery, or the incidence of anuria among patients. [doi.org]

• Confusion

  If you're confused about what exactly your doctor means, you should ask her to explain. Septicemia is a bacterial infection that spreads into the bloodstream. [verywellhealth.com]

  (Redirected from Mental confusion) Confusion Specialty Psychiatry In medicine, confusion is the quality or state of being bewildered or unclear. [en.wikipedia.org]

  Common symptoms of sepsis are fever, chills, rapid breathing and heart rate, rash, confusion and disorientation. [cottagehealth.org]

  […] of the following symptoms may be present: Infection Elevated temperature, greater than 38.30C or 101.30F Fast heart rate, greater than 90 beats per minute Fast respiratory rate, greater than 20 breaths per minute Other symptoms that may be present: Confusion [christopherreeve.org]

• Altered Mental Status

  We report the case of a woman who presented with altered mental status after receiving normal saline through an intravenous catheter placed by a medically untrained individual. [ncbi.nlm.nih.gov]

  Fever, chills, and diaphoresis Tachycardia Tachypnea Features of organ dysfunction (see SOFA score) CNS impairment: altered mental status Cardiovascular failure: hypotension Coagulopathy → disseminated intravascular coagulation → petechiae, purpura Liver [amboss.com]

  Severe sepsis is diagnosed when the septic patient has organ dysfunction (for example, low or no urine flow, altered mental status). [medicinenet.com]

• Lethargy

  CASE PRESENTATION: A term male infant presented on day 4 of post-natal life with the complaint of decreased appetite, fast respiration and lethargy. The clinical examination showed features of sepsis and shock with chest radiogram showing pneumonia. [ncbi.nlm.nih.gov]

  Streptococcus pneumoniae Staphylococcus aureus (MSSA or MRSA) Group A Streptococcus (GAS) Assessment Sepsis or septic shock should be considered in a patient with a suspected or proven bacterial infection AND any of the following Altered conscious state (lethargy [rch.org.au]

  The cardinal symptoms of sepsis include: Fever, chills or hypothermia Hypotension and oliguria Hyperventilation Mental status changes Skin manifestations These features may be preceded by lethargy, headache and minor changes in consciousness. [symptoma.com]

  […] potential infections Prevent infections that can lead to sepsis by: Cleaning scrapes and wounds and practicing good hygiene by washing hands and bathing regularly If you have an infection, look for signs like: Fever and chills Extreme weakness, dizziness, lethargy [cottagehealth.org]

• Headache

  Infection and sepsis has been reported as a possible cause for this disorder.We present a 19-year-old immunocompetent Caucasian man with known type 1 diabetes mellitus who presented to the emergency department with acute onset of bilateral visual loss, headaches [ncbi.nlm.nih.gov]

  The cardinal symptoms of sepsis include: Fever, chills or hypothermia Hypotension and oliguria Hyperventilation Mental status changes Skin manifestations These features may be preceded by lethargy, headache and minor changes in consciousness. [symptoma.com]

  The most common symptoms of pneumonia are: Fever Cough, with phlegm Shortness of breath Sweating Shaking chills Headache Muscle pain Fatigue Chest pain with breathing If you have pneumonia, you may be told that there isn’t any treatment if you have viral [sepsis.org]

  It is characterized by fever, stiff neck, and headache, with vomiting, photophobia and confusion in many cases. These may not be present in the very young. [news-medical.net]

Early diagnosis and treatment of sepsis is the basic key in preventing the morbidity and mortality resulting from the sepsis.
Cardiac monitoring, blood pressure monitoring and pulse oxymetry are indicated in patients with septic shock. Once the patient is stabilized, the clinicians can move forward to the diagnostic workup. This involves the use of the following investigation to determine the cause and site of infection:

• Blood CP
• Blood culture
• Chest radiography
• Ultrasound abdomen and pelvis
• Urea & creatinine levels
• Liver function tests
• Sputum culture
• Urine culture
• Arterial blood gases
• Coagulation profile

• Hypoglycemia

  Other[edit] Acute stress reaction Alcoholism Anemia ALANA Anxiety Brain damage Brain tumor Concussion Dehydration Encephalopathy Epileptic seizure Depression Fatigue Fever Brain injury Heat stroke Hypoglycemia Hypothermia Hypothyroidism Jet lag Kidney [en.wikipedia.org]

  Hypoglycemia, or low blood sugar. Meningitis: Swelling (inflammation) of the membranes covering the brain and spinal cord caused by infection. This disease is usually diagnosed shortly after birth, often while the baby is still in the hospital. [medlineplus.gov]

  Patients treated with intensive insulin experienced significantly more episodes of severe hypoglycemia ( P = .003). [jama.ama-assn.org]

• Clostridium Perfringens

  Blood culture was positive for C perfringens. Patient died after 48 hours, with signs of multiorgan failure. CONCLUSIONS: Clostridium perfringens sepsis is severe and usually lethal in the transplant population. [ncbi.nlm.nih.gov]

• Leukocytosis

  They include malaise, leukocytosis, tachypnoea, and pulse >90 bpm. Sepsis can progress rapidly to multi-organ failure and shock, and is often fatal. [bestpractice.bmj.com]

  […] with a history of suspected giant cell aortitis, previous surgical treatment of ascendant and descendant thoracic aortic aneurysm, presenting 7 years after thoracic endovascular aneurysm repair with thoracic pain, fever, inflammatory indexes increase, leukocytosis [ncbi.nlm.nih.gov]

  […] inflammation is recognized as rubor (redness), tumor (swelling), calor (heat) and dolor (pain), and when a systemic response is elicited, it is called SIRS (Systemic Inflammatory Response Syndrome), which consists of tachypnea, tachycardia, hyperpyrexia and leukocytosis [blogs.biomedcentral.com]

  […] core temperature > 38.3℃)    Hypothermia (core temperature < 36℃)    Heart rate > 90 beats/min    Tachypnea    Altered mental status    Significant edema or positive fluid balance    Hyperglycemia in the absence of diabetes   Inflammatroy variables    Leukocytosis [ekjm.org]

The following goals should be kept in mind while treating the patients with septic shock:

• Adequate antibiotic therapy should be started as early as possible (within one hour of making the diagnosis in severe sepsis) [8].
• In severe sepsis, resuscitation is performed during the first six hours to enhance the heart function in order to correct hypoxia, hypotension and hypoperfusion [9]. This is known as early goal directed therapy and effectively reduces mortality in these patients [10].
• The source of infection should be identified identify and should be managed with anti-microbial therapy, surgery or both.
• Adequate organ system function should be maintained.

The mortality resulting from sepsis is usually quoted to be in the range of 20-50% [7]. However, with the advances in the clinical trials in the past ten years, the mortality rate has been limited to 24 to 41%. The mortality greatly depends on the severity of illness.

The severity of the illness and the prognosis depend on the causative organism, site of infection, the strength of the patient’s immune system, the presence of any underlying disease and the developmet of septic shock.

There are number of causes which lead to the development of sepsis. Most of these causes are bacterial in nature but viruses and fungi can also cause sepsis.

The common gram positive organisms that cause sepsis include Staphylocossus, Streptocossus and Enterococcus; whereas Proteus, Pseudomonas and Klebsiella are the common gram negative organisms.

In previously healthy adults, the most common sources of infection are intraabdominal infections, urinary tract infections and pneumonia. In many cases of septicemia, the focus of infection may not be apparent.

Few other rare causes include parasites, fungi, viruses and mycobacteria.

The common predisposing conditions for gram negative bacteremia include diabetes mellitus, lymphoproliferative disorders, cirrhosis of liver, burns, invasive procedures and neutropenia.

In contrast, intravenous drug abuse, vascular catheterization, the presence of indwelling mechanical devices and burns are the predisposing conditions for gram positive bacteremia.

Immunosuppression and broad-spectrum antimicrobial therapy predispose the patient to fungemia.

In the United States, the per annum episodes of sepsis are 400,000 to 750,000. Sepsis is more common in the extremes of ages such as infancy or old age. Statistical data shows that the male gender more commonly develops sepsis; the sex ratio being 1.5:1.

The development of sepsis is favored by poor hygienic conditions and overcrowding. 5-10% of gram positive bacteremias and 50-60% of gram negative bacteremias are complicated by sepsis.

The septic response results from the microbial signals or toxins coupled with the body response in the form of formation of cytokines, prostaglandins and the activation of complement C5a.

Microbial factors

Bacterial signals initiate the release of inflammaory mediators from leukocytes and endothelial cells. Exotoxins (such as peptoglycan and lipoteichoic acid produced by gram positive organisms) and endotoxins (such as lipopolysacchardie produced by gram negative organisms) are the important microbial factors in this regard.

Body response

There is convincing evidence to support the belief that sepsis develops from exaggerated systemic inflammatory response which is induced by infecting organisms. Some of the inflammatory mediators include TNF (tumor necrosis factor), cytokines, leukotrienes, interleukins, eicosanoids, interferon gamma, selectins and complement C5a [3][4][5].

The interaction of these mediators leads to an inflammatory cascade of reactions that causes widespread endothelial damage, hypotension, refractory shock and multiorgan failure.

Abnormalities of coagulation and fibrinolysis

As a result of endothelial damage, clotting factors and the extrinsic clotting cascade are activated. This leads to disseminated intra-vascular coagulation (DIC) and microvascular thrombosis which ultimately results in organ dysfunction and death [6].

Circulatory abnormalities

Distributive shock is characterized by the pathological vasodilatation and shunting of blood from vital to non-vital tissues and organs. Septic shock falls under this category. Disturbances in blood flow, micro-circulation and peripheral shunting of oxygen result in the deficiency of oxygen and accumulation of lactic acid.

Organ dysfunction and failure

As a result of the abnormalities in circulation, coagulation, peripheral shunting and chemical mediators, the main systems and organs of the body fail to function properly. The improper oxygenation that develops ultimately leads to organ failure and death.

Promotion of the hygienic conditions and prevention of overcrowding greatly prevents sepsis. High risk individuals must be identified beforehand to ensure early diagnosis.

Sepsis can be defined as the systemic inflammatory response to microbial invasion. It is characterized by the presence of two or more of the following  four conditions [1].

• Oral temperature greater than 38°C or less than 36°C
• Heart rate more than 90 beats/minutes
• Respiratory rate more than 20 breaths/minute; or less than 32 torr partial pressure of carbon dioxide.
• Leukocyte count of more than 12,000 cells/mm3 or less than 4000 cells/mm3 or greater than 10% band forms

Dysfunction of major organs occurs in severe sepsis and may lead to septic shock. Septic shock can be defined as sepsis with hypotension that is unresponsive to fluid resuscitation with signs of organ dysfunction and perfusion abnormalities such as metabolic acidosis, acute alteration in mental status, oliguria or adult respiratory distress syndrome.

Early sepsis is usually reversible whereas patients with septic shock often die even if aggressive therapy is provided. For this reason, it is necessary to detect the cause of sepsis and treat it as early as possible. Sepsis causes millions of death each year [2].

Sepsis is a condition in which in which microorganisms or their toxins are present in the blood. It is characterized by fever, fast breathing and heart rate and an increase in white blood cell count. Individuals at the extremes of ages (old age or infancy) or those who have poor health, or unhygienic living conditions are more prone to the development of sepsis. Sepsis can be fatal if not diagnosed and managed promptly.

1. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Critical care medicine. Apr 2003;31(4):1250-1256.
2. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Critical care medicine. Jan 2008;36(1):296-327.
3. Salles MJ, Sprovieri SR, Bedrikow R, et al. [Systemic inflammatory response syndrome/sepsis--review and terminology and physiopathology study]. Revista da Associacao Medica Brasileira. Jan-Mar 1999;45(1):86-92.
4. Avdeeva MG, Shubich MG. [Pathogenetic mechanisms of the initiation of systemic inflammatory response syndrome (a literature review)].
5. Klinicheskaia laboratornaia diagnostika. Jun 2003(6):3-10.
   Jaffer U, Wade RG, Gourlay T. Cytokines in the systemic inflammatory response syndrome: a review. HSR proceedings in intensive care & cardiovascular anesthesia. 2010;2(3):161-175.
6. Nimah M, Brilli RJ. Coagulation dysfunction in sepsis and multiple organ system failure. Critical care clinics. Jul 2003;19(3):441-458.
7. Russel JA. The current management of septic shock. Minerva medica. Oct 2008;99(5):431-458.
8. Soong J, Soni N. Sepsis: recognition and treatment. Clinical medicine. Jun 2012;12(3):276-280.
9. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. The New England journal of medicine. Nov 8 2001;345(19):1368-1377.
10. Jones AE, Brown MD, Trzeciak S, et al. The effect of a quantitative resuscitation strategy on mortality in patients with sepsis: a meta-analysis. Critical care medicine. Oct 2008;36(10):2734-2739.