The correct answer is:

According to the currently endorsed sepsis-3 definitions and the recently reinstated systemic inflammatory response syndrome (SIRS) criteria, she is presenting with likely sepsis.

Educational Objective:

Define sepsis and septic shock as well as the recommended sepsis screening tools according to the 2021 SSC guidelines as compared to the 2016 guidelines.

Key Points:

The category severe sepsis (rescinded in 2016) and the screening tool qSOFA (rescinded in 2021) are no longer part of current (2021) sepsis guidelines (hence the above answers containing those elements are false).

Explanation:

Sepsis definitions and recommended screening tools have undergone some growing pains over the last several years.

Note: the FORMER (now outdated) SEPSIS DEFINITIONS (still a useful starting point) can be found here.

Before 2016, the recommended sepsis definitions were sepsis, severe sepsis, and septic shock. They were designed to specifically work with the SIRS criteria as a screening tool.

2016-2021 EVOLUTION OF SEPSIS DEFINITIONS AND SCREENING TOOLS:

In 2016, the Third Conference on The Definition of Sepsis made the term sepsis an all-encompassing term, with septic shock becoming a subcategory of sepsis, and the category of severe sepsis being dropped. These new definitions became known as the sepsis-3 definitions (because they were developed during the Third Conference on The Definition of Sepsis).

At the same time (2016), the SIRS criteria were no longer endorsed for sepsis screening. Rather, the new sepsis-3 definition of sepsis in particular (now an all-encompassing term) was designed to work with the newly developed qSOFA sepsis screening tool.

However, qSOFA did not perform as expected in the emergency department (it was developed in the ICU).

The 2021 guidelines ended up retaining the 2016 sepsis-3 definitions for sepsis (all-encompassing term) and septic shock (a subcategory of sepsis), but rescinding the qSOFA screening tool. Instead, the 2021 guidelines recommend reverting back to the previously SIRS criteria or using the National Early Warning Score (NEWS) or the Modified Early Warning Score (MEWS) tools.

Since the sepsis-3 definition of sepsis in particular (tailored to qSOFA) was not designed to work with the SIRS, NEWS, or MEWS criteria, the 2021 guidelines create some uncertainty as to when a patient should be diagnosed as having sepsis (note that sepsis screening tools are not designed to differentiate the all-encompassing term sepsis from the subcategory of septic shock).

2021 DEFINITION OF AND SCREENING FOR SEPSIS:

Click here for the sepsis-3 definition of sepsis (the all-encompassing term) and a discussion on using currently endorsed screening tools to identify it.

SEPTIC SHOCK:

Initial sepsis screening tools are only designed to detect sepsis (since 2016, an all-encompassing term), not to differentiate between sepsis and septic shock (since 2016, a subcategory of sepsis). Notice that initial identification of the septic shock subgroup is irrelevant because the first steps of resuscitation are the same for both groups.

The definition of septic shock - sepsis that does not stabilize with fluid resuscitation - is purposefully designed to be a delayed diagnosis that becomes available when the first branching point in care has been reached (after fluid resuscitation). At this time only, hemodynamic nonresponders (septic shock) require intensification of resuscitation efforts (e.g. vasopressors).

Both hemodynamic responders and non-responders can initially present with hypotension - both groups initially receive the same, all-encompassing diagnosis of sepsis.

Click here for the sepsis-3 definition of septic shock (a subcategory to sepsis).

References: