Sepsis and ICU Multi-Score Calculator

qSOFA, SOFA, NEWS and APACHE II on one set of observations, and the trajectory · v1.6

  • Enter the vitals, biochemistry and organ support.
  • For ward triage: NEWS, MEWS and qSOFA.
  • For the Sepsis-3 diagnosis and the prognosis: SOFA and APACHE II, with the delta SOFA where a previous score is entered.
  • Plus an SBAR handover you can copy into the notes.
  • Read the APACHE II mortality as the outcome of a group of patients scoring the same, not as a prediction about this one.
  • Open it for suspected sepsis, undifferentiated shock or unexplained physiological deterioration.

  • Children and adolescents under 18. These scores are validated in adults; use pSOFA or PELOD-2 instead.
  • The organism, the antibiotic and the source control decision. It scores the patient in front of you.
  • Ventilator settings, fluid volumes and vasopressor doses. The infusion arithmetic belongs to the ICU infusion dosing tool in this catalogue.
  • A PaCO2. APACHE II assumes 40 mmHg wherever the alveolar-arterial gradient is used, and the gradient shifts by 1.25 mmHg for every mmHg the real value differs.

1. Patient Baseline & Trajectory

2. Vital Signs & Neurology

3. Perfusion & Oxygenation

Note: Vasopressin is not an independent parameter in the SOFA algorithm.

4. Laboratory Parameters (optional: NEWS, MEWS and qSOFA are calculated without them)

2026 Sepsis Evidence & Diagnostics

1. 2026 Surviving Sepsis Campaign (SSC) Updates

  • Screening Shift: The 2026 SSC guidelines explicitly recommend NEWS, MEWS, or SIRS over qSOFA as a single screening tool for sepsis identification in hospitalised patients.
  • MAP Targets (Age ≥ 65): A lower initial Mean Arterial Pressure (MAP) target of 60–65 mm Hg is now suggested for elderly patients with septic shock to reduce vasopressor-induced arrhythmias and adverse events.
  • Antimicrobial Stewardship: Anaerobic cover is suggested only where there are specific risk factors for anaerobic infection (conditional recommendation, very low certainty of evidence).

2. Sepsis vs. Septic Shock (Sepsis-3 Criteria)

  • Sepsis: Life-threatening organ dysfunction (an acute change in total SOFA score of ≥ 2 points) caused by a dysregulated host response to infection.
  • Septic Shock: A profound circulatory and cellular abnormality identified by a vasopressor requirement to maintain MAP ≥ 65 mm Hg AND serum lactate > 2 mmol/L despite adequate fluid resuscitation. Hospital mortality in this phenotype is above 40%.
  • Delta SOFA Trajectory: A single SOFA score gives baseline mortality risk. The 48-hour Delta SOFA is the more prognostic of the two, and a rising score points hard at source control that has not been achieved or antimicrobials that are not covering the organism.

3. ANDROMEDA-SHOCK & Capillary Refill Time (CRT)

In ANDROMEDA-SHOCK, resuscitation targeted to peripheral perfusion, using a Capillary Refill Time of ≤ 3 seconds measured the same way every time, was non-inferior to lactate-targeted resuscitation for guiding early fluid therapy in septic shock, and possibly better than it. A prolonged CRT costs nothing and it reads at the bedside in seconds. It marks failure of the macrocirculation and the microcirculation together.

4. Practice Advisories: Indian Clinical Context

The Leptospirosis serology caution: do not wait for serology to start Ceftriaxone or Doxycycline. IgM antibodies take up to 3 weeks to become positive, so in the first 1–3 weeks the serology you are waiting for cannot help you. Leptospirosis is a clinical diagnosis in that window: exposure history, conjunctival suffusion, severe myalgia with calf tenderness. It accounts for a large share of the acute kidney injury and shock seen in the tropics, which is why the empirical cover goes in early.
Fluid Resuscitation Points to Note: Resuscitate with a balanced crystalloid, Ringer's Lactate or Plasmalyte. Both ICMR and Surviving Sepsis put it first line. Large-volume 0.9% Normal Saline produces a hyperchloraemic metabolic acidosis and worsens the renal vasoconstriction you are trying to reverse.

5. Top Differential Diagnoses (Shock with Multiorgan Failure)

Differential Key Differentiating Features Initial Investigation
Tropical Fevers
(Dengue, Malaria, Scrub Typhus, Leptospirosis, Enteric Fever, Melioidosis)		 Eschar (Scrub), severe thrombocytopaenia with haemoconcentration (Dengue), cyclical fever with rigors (Malaria), conjunctival suffusion/calf tenderness (Lepto), step-ladder fever (Enteric), parotid swelling/abscesses (Melioidosis). Peripheral smear, NS1/IgM, Weil-Felix/IgM Scrub, Lepto IgM (late), Blood culture (Salmonella/Burkholderia).
Cardiogenic Shock Elevated JVP, pulmonary oedema, S3 gallop, absence of typical infectious prodrome. Cold peripheries. Bedside 2D Echo, ECG, Troponins.
Acute Severe Pancreatitis Severe epigastric pain radiating to the back. Rapid onset third-spacing and ARDS mimicking sepsis. Serum Lipase/Amylase, USG/CECT Abdomen.
Abbreviations ABG (Arterial Blood Gas) · APACHE II (Acute Physiology and Chronic Health Evaluation II) · ARDS (Acute Respiratory Distress Syndrome) · BiPAP (Bilevel Positive Airway Pressure) · BP (Blood Pressure) · CECT (Contrast-Enhanced Computed Tomography) · COPD (Chronic Obstructive Pulmonary Disease) · CPAP (Continuous Positive Airway Pressure) · Cr (Creatinine) · CRT (Capillary Refill Time) · ECG (Electrocardiogram) · E, V, M (Eye, Verbal and Motor Components of the Glasgow Coma Scale) · FiO₂ (Fraction of Inspired Oxygen) · GCS (Glasgow Coma Scale) · HR (Heart Rate) · ICMR (Indian Council of Medical Research) · ICU (Intensive Care Unit) · IgM (Immunoglobulin M) · JVP (Jugular Venous Pressure) · MAP (Mean Arterial Pressure) · MEWS (Modified Early Warning Score) · NEWS (National Early Warning Score) · NIV (Non-Invasive Ventilation) · NS1 (Non-Structural Protein 1) · NYHA (New York Heart Association) · O₂ (Oxygen) · PaO₂ (Partial Pressure of Arterial Oxygen) · PELOD-2 (Paediatric Logistic Organ Dysfunction Score, Version 2) · Post-Op (Postoperative) · pSOFA (Paediatric Sequential Organ Failure Assessment) · qSOFA (Quick Sequential Organ Failure Assessment) · RR (Respiratory Rate) · SBAR (Situation, Background, Assessment, Recommendation) · Sepsis-3 (Third International Consensus Definitions for Sepsis and Septic Shock) · SIRS (Systemic Inflammatory Response Syndrome) · SOFA (Sequential Organ Failure Assessment) · SpO₂ (Peripheral Capillary Oxygen Saturation) · SSC (Surviving Sepsis Campaign) · UO (Urine Output) · USG (Ultrasonography) · WBC (White Blood Cell)
References
  1. Prescott HC, Antonelli M, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026. Intensive Care Med. 2026;52(5):863-936. PMID 41870560. Published simultaneously in Critical Care Medicine; the Intensive Care Medicine citation is the one verified here, on 28 August 2026. A publisher correction appeared at Intensive Care Med. 2026;52(6):1411-1413 (PMID 42084789).
  2. Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-810. PMID 26903338.
  3. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94(10):521-526. PMID 11588210.
  4. Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019;321(7):654-664. PMID 30772908.
  5. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-829. PMID 3928249.
  6. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med. 1996;22(7):707-710. PMID 8844239.
  7. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762-774. PMID 26903335.
  8. Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP; 2017.
How to Cite This Tool

DOIhttps://doi.org/10.5281/zenodo.22401641

AMA Style:Umakanth S. Sepsis and ICU Multi-Score Calculator. Version 1.6. MEDiscuss Clinical Decision Support System. Published 2026. Accessed . https://mediscuss.org/cdss/sepsis-icu-synthesiser. doi:10.5281/zenodo.22401641

Vancouver Style:Umakanth S. Sepsis and ICU Multi-Score Calculator [Internet]. Version 1.6. MEDiscuss.org; 2026 [cited ]. Available from: https://mediscuss.org/cdss/sepsis-icu-synthesiser. doi:10.5281/zenodo.22401641

Disclaimer and scope
Disclaimer: This decision-support system is written for healthcare professionals. It does not substitute clinical judgment, and the treating physician retains absolute responsibility for every diagnostic, dosing and therapeutic decision. The algorithms are built on the evidence as it stands, and the evidence moves. Verify the output against your current institutional protocol, and against the patient in front of you.
© 2026 MEDiscuss.org. All rights reserved. Provided free of charge for clinical use. Unauthorised reproduction or redistribution is strictly prohibited.
Category Acute ResuscitationCalculator
Specialties Internal Medicine, Critical Care, Infectious Diseases
Status Essential

Written and maintained by

Dr Shashikiran Umakanth

Last revised 24 August 2026

How these tools are written and reviewed

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