Sepsis & ICU Multi-Score Synthesiser

Dynamic Trajectory, 2026 SSC Updates & APACHE II · v6.0
⚙ Indications: Suspected sepsis, undifferentiated shock, or unexplained physiological deterioration.
⚠ CONTRAINDICATION: Validated for ADULTS (≥18 years) only. Do not use for paediatric age groups (use pSOFA or PELOD-2 instead).

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 for Basic Triage)

⚙ 2026 Sepsis Evidence & Diagnostics

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 hospitalized 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: There is a strong conditional recommendation against the use of empiric anti-anaerobic antibiotics in patients at low risk for anaerobic infections.

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. This specific phenotype carries a hospital mortality rate >40%.
  • Delta SOFA Trajectory: A static SOFA score provides baseline mortality risk, but the 48-hour $\Delta$ SOFA is highly prognostic. A rising score strongly indicates inadequate source control or inappropriate antimicrobials.

ANDROMEDA-SHOCK & Capillary Refill Time (CRT)

The ANDROMEDA-SHOCK trial demonstrated that peripheral perfusion-targeted resuscitation (using a standardized Capillary Refill Time $\le$ 3 seconds) is non-inferior—and potentially superior—to lactate-targeted resuscitation for guiding early fluid therapy in septic shock. Prolonged CRT is a zero-cost, real-time bedside marker of profound macro/micro-circulatory failure.

Practice Alerts: Indian Clinical Context

⚠ The Leptospirosis Serology Trap: Leptospirosis is a massive driver of acute kidney injury and shock in the tropics. Do not wait for serology to start Ceftriaxone or Doxycycline. IgM antibodies take up to 3 weeks to become positive. In the first 1–3 weeks, Leptospirosis is strictly a clinical diagnosis based on exposure history, conjunctival suffusion, and severe myalgia (calf tenderness).
⚠ Fluid Resuscitation Pitfalls: Aggressive volume expansion with 0.9% Normal Saline leads to hyperchloraemic metabolic acidosis, exacerbating renal vasoconstriction. ICMR and Surviving Sepsis guidelines recommend balanced crystalloids (e.g., Ringer's Lactate or Plasmalyte) as first-line therapy.

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: NEWS (National Early Warning Score) · MEWS (Modified Early Warning Score) · qSOFA (Quick Sequential Organ Failure Assessment) · SOFA (Sequential Organ Failure Assessment) · APACHE II (Acute Physiology and Chronic Health Evaluation II) · MAP (Mean Arterial Pressure) · CRT (Capillary Refill Time)
Algorithm References & Evidence Base
  1. Prescott HC, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026. Crit Care Med. 2026.
  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.
  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.
  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.
  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.
How to Cite This Tool

AMA Style:
Umakanth S. Sepsis & ICU Multi-Score Synthesiser. MEDiscuss. Published 2026. Accessed .

Vancouver Style:
Umakanth S. Sepsis & ICU Multi-Score Synthesiser [Internet]. MEDiscuss.org; 2026 [cited ]. Available from:

⚠ Disclaimer: This decision-support system is intended for healthcare professionals. It does not substitute clinical judgment. These algorithms are evidence-based, but medical knowledge evolves continuously. The treating physician retains absolute responsibility for all diagnostic, dosing, and therapeutic decisions. Always verify outputs against current institutional protocols and individual patient contexts.
© 2026 MEDiscuss.org. All rights reserved. This CDSS Module was designed and developed by
Dr. Shashikiran Umakanth using the available evidence base. Provided free of charge for clinical use. Unauthorised reproduction or redistribution is strictly prohibited.
Category Therapeutic Pathways & Algorithms
Specialties Internal Medicine, Critical Care, Infectious Diseases
Status New Pathway
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