الفهرس 
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Abstract
Sepsis is a life-threatening health problem that is associated with high morbidity and
mortality. The first definition of sepsis was dependent on systemic inflammatory response
syndrome (SIRS) criteria that comprise fever/hypothermia, tachycardia, tachypnea and
leukocytosis/leukocytopenia (Bone et al. 1992). In 1991, the first consensus definition of sepsis
characterized it by the fulfillment of at least two SIRS criteria with suspected or proven infection
(Bone et al. 1992). This definition, however, focused only on host response to deleterious insults
and can be easily met in many patients who only experienced an acute infection (Vincent et al.
2013). Now, sepsis is defined according to the Third International Consensus Definitions for
Sepsis as “a life-threatening organ dysfunction caused by a dysregulated host response to
infection” and septic shock is defined as “a subset of sepsis in which underlying circulatory and
cellular metabolism abnormalities are profound enough to substantially increase mortality”
(Singer et al. 2016). Septic shock can be clinically characterized by the need to vasopressor
administration to maintain a mean arterial pressure (MAP) ≥ 65 mmHg and serum lactate level
>18 mg/dl despite sufficient fluid resuscitation (Singer et al. 2016).
Sepsis-induced organ dysfunction is indicated by an increase of two or more in the
Sequential Organ Failure Assessment (SOFA) score (Vincent et al. 1996). SOFA addresses
dysfunction of six systems: cardiovascular, renal, respiratory, hepatic, coagulation, and central
nervous system (CNS). It is widely accepted that increased SOFA score is positively correlated
with mortality rate in septic patients (Vincent et al. 1998). A newer system named quick SOFA
(qSOFA) comprises three clinical criteria: respiratory rate ≥22/min, systolic blood pressure ≤ 100
mmHg and altered mental state; the presence of at least two of which indicates sepsis (Singer et
al. 2016). The advantages of qSOFA include rapid identification and treatment of septic patients
and more frequent follow ups (Gül et al. 2017).
According to the latest World Health Organization report on the epidemiology of sepsis,
it is estimated that sepsis affects about 50 million people annually and is responsible for
approximately 20% of all-cause mortality worldwide (Rudd et al. 2020). Sepsis incidence
increases in neonates, children and elderly with approximately 40% of sepsis cases were reported
in early childhood in 2017 (Vos et al. 2017). Recent studies reported that about three quarters of
COVID-19 patients in intensive care units have sepsis (Karakike et al. 2021). Being a lifethreatening health condition, sepsis causes death in nearly half of in-hospital septic patients and
disabling complications in survivors (Iwashyna et al. 2010, Prescott et al. 2016, Lorencio
Cárdenas et al. 2022).