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What are the diagnostic criteria for septic shock?

Nov 25, 2025 Source: Cainiu Health
Dr. Wang Lei
Introduction
In general, septic shock—a life-threatening syndrome triggered by severe infection—is diagnosed based on criteria including clear evidence of infection, persistent hypotension, organ dysfunction, inadequate tissue perfusion, and abnormal inflammatory markers. The diagnosis of septic shock requires a comprehensive assessment of multiple indicators, and clinicians make an overall evaluation by integrating the patient's medical history, clinical signs, and test results.

Generally, septic shock—a life-threatening syndrome caused by severe infection—is diagnosed based on criteria including clear evidence of infection, persistent hypotension, organ dysfunction, inadequate tissue perfusion, and abnormal inflammatory markers. A detailed analysis is as follows:

1. Clear evidence of infection: Clinical signs of infection such as fever or hypothermia must be present, supported by laboratory or imaging findings—for example, abnormal white blood cell count in complete blood count, positive pathogen culture results, or CT scans revealing infectious foci.

2. Persistent hypotension: Systolic blood pressure remains below 90 mmHg, or decreases by more than 40 mmHg from baseline, unresponsive to fluid resuscitation. Even with vasopressor support, blood pressure cannot be maintained within the normal range, representing a core feature of circulatory failure.

3. Organ dysfunction: At least one sign of organ impairment must be present, such as renal or hepatic dysfunction, altered mental status, or respiratory failure requiring mechanical ventilation.

4. Inadequate tissue perfusion: Manifested by cold, clammy skin, cyanosis, or mottling, along with decreased extremity temperature. Some patients may exhibit prolonged capillary refill time, indicating poor peripheral tissue perfusion and accumulation of metabolic waste products.

5. Abnormal inflammatory markers: Elevated levels of inflammatory biomarkers, such as C-reactive protein >20 mg/L, procalcitonin >0.5 ng/mL, or white blood cell count >12×10⁹/L or <4×10⁹/L, suggest a significant systemic inflammatory response.

Diagnosing septic shock requires integration of multiple indicators. Clinicians make comprehensive assessments based on patient history, physical examination, and test results. Early recognition and prompt intervention are crucial for improving prognosis.

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