High risk of severe illness or death from sepsis
In January 2024, we updated the recommendations in this section to incorporate use of NEWS2.
We did not review the evidence on other aspects of management. Evidence for tests and interventions recommended in this section was last reviewed in 2016. We are currently reviewing the evidence and will consider making new recommendations or updating existing recommendations on:
This update is expected to publish in 2025. See the update page for more information.
A person is at high risk of severe illness or death from sepsis if they have suspected or confirmed infection and a NEWS2 score of 7 or above.
A person is also at high risk of severe illness or death from sepsis if they have suspected or confirmed infection, a NEWS2 score below 7, and:
1.13.2
For people aged 16 or over who are at high risk of severe illness or death from sepsis:
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arrange for a clinician with core competencies in the care of acutely ill patients (FY2 level or above) to urgently assess the person's condition and think about alternative diagnoses to sepsis
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carry out a venous blood test, including for:
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give antibiotics in line with recommendation 1.13.3 and the recommendations on choice of antibiotic therapy
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refer to the senior clinical decision maker as soon as possible
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use
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clinical judgement to decide whether to discuss with a consultant.
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[2024]
Intravenous fluids
1.13.4
For people aged 16 or over with a high risk of severe illness or death from sepsis and either lactate over 2 mmol/litre or systolic blood pressure less than 90 mmHg, give intravenous fluid bolus without delay (within 1 hour of identifying that they are at high risk) in line with recommendations on intravenous fluids for people with suspected sepsis. [2024]
1.13.5
Monitoring and escalation
1.13.6
1.13.7
If a person aged 16 years or over who is at high risk of severe illness or death from sepsis does not respond within 1 hour of any intervention:
Moderate risk of severe illness or death from sepsis
A person is at moderate risk of severe illness or death from sepsis if they have suspected or confirmed infection and a NEWS2 score of 5 or 6.
A person is also at moderate risk of severe illness or death from sepsis if they have suspected or confirmed infection, a NEWS2 score below 5, and:
1.13.8
For people aged 16 or over with moderate risk of severe illness or death from sepsis:
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carry out a venous blood test, including for:
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arrange for a clinician with core competencies in the care of acutely ill patients (FY2 level or above) to review the person's condition and venous lactate results within 1 hour of the person being assessed as at moderate risk. [2024]
1.13.9
For people at moderate risk of severe illness or death from sepsis, a clinician with core competencies in the care of acutely ill patients (FY2 level or above) should consider:
1.13.10
For someone with a NEWS2 score of 5 or 6 and a single parameter contributing 3 points to their total NEWS2 score, use clinical judgement to determine the likely cause of the 3 points in one parameter. If the likely cause is:
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the current infection, manage as high risk and give broad-spectrum antibiotic treatment in line with recommendation 1.13.3
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something else (such as a pre-existing condition), manage as moderate risk and follow recommendation 1.13.9. [2024]
1.13.11
For people aged 16 or over at moderate risk of severe illness or death from sepsis:
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recalculate the NEWS2 score periodically, in line with the recommendations on when to recalculate a NEWS2 score
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if there is deterioration or no improvement, escalate care to a clinician with core competencies in the care of acutely ill patients (FY2 level or above). [2024]
1.13.12
For people aged 16 or over with a moderate risk of severe illness or death from sepsis and either lactate over 2 mmol/litre or evidence of acute kidney injury, treat their condition as if they were at high risk of severe illness or death from sepsis.
For definition of acute kidney injury, see NICE's guideline on acute kidney injury. [2024]
Low risk of severe illness or death from sepsis
A person is at low risk of severe illness or death from sepsis if they have suspected or confirmed infection and a NEWS2 score of 1 to 4 (see recommendation 1.11.4 on evaluating risk of severe illness or death from sepsis) or a NEWS2 score of 0 and cause for clinical concern (see recommendations 1.11.6 and 1.11.7 on taking causes for clinical concern into account when evaluating risk of severe illness or death from sepsis).
1.13.13
For people aged 16 or over at low risk of severe illness or death from sepsis:
1.13.14
For people at low risk of severe illness or death from sepsis, request assessment by a clinician with core competencies in the care of acutely ill patients (FY2 level or above) for them to consider:
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deferring administration of a broad-spectrum antibiotic treatment for up to 6 hours after calculating the person's first NEWS2 score on initial assessment in the emergency department or on ward deterioration and
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using this time to gather information for a more specific diagnosis (see recommendations on finding and controlling the source of infection and choice of antibiotic therapy).
Once a decision is made to give antibiotics, do not delay administration any further. [2024]
1.13.15
For someone with a NEWS2 score of 3 or 4 and a single parameter contributing 3 points to their total NEWS2 score, use clinical judgement to determine the likely cause of the 3 points in one parameter. If the likely cause is:
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the current infection, manage as moderate or high risk and:
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something else (such as a pre-existing condition), manage as low risk and follow recommendation 1.13.14. [2024]
1.13.16
For people aged 16 or over at low risk of severe illness or death from sepsis:
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recalculate the NEWS2 score periodically, in line with the recommendations on when to recalculate a NEWS2 score
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if there is deterioration or no improvement, escalate care to a clinician with core competencies in the care of acutely ill patients (FY2 level or above). [2024]