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Table 6 Phoenix Sepsis Score

From: The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024

Variables

0 Points

1 Point

2 Points

3 Points

Respiratory (0–3 points)

 

PaO2/FIO2 ratio ≥ 400 or SpO2/FIO2 ≥ 292a

PaO2/FIO2 ratio < 400 on any respiratory support or SpO2/FIO2 ratio < 292 on any respiratory supporta,b

PaO2/FIO2 ratio 100–200 and IMV or SpO2/FIO2 ratio 148–220 and IMVa

PaO2/FIO2 ratio < 100 and IMV or SpO2/FIO2 ratio < 148 and IMVa

Cardiovascular (0–6 points)

  

1 point each (up to 3) for:

2 points each (up to 6) for:

 
 

No vasoactive medicationsc

1 vasoactive medicationsc

 ≥ 2 vasoactive medicationsc

 
 

Lactate < 5 mmol/Ld

Lactate 5–10.9 mmol/Ld

Lactate ≥ 11 mmol/Ld

 

Mean arterial pressure by age, mmHge,f

 < 1 month

 > 30

17–30

 < 17

 

1–11 months

 > 38

25–38

 < 25

 

1 to < 2 years

 > 43

31–43

 < 31

 

2 to < 5 years

 > 44

32–44

 < 32

 

5 to < 12 years

 > 48

36–48

 < 36

 

12 to < 17 years

 > 51

38–51

 < 38

 

Coagulation (0–2 points)g

  

1 point each (maximum of 2 points) for:

  
 

Platelets ≥ 100 × 103/μL

Platelets < 100 × 103/μL

  
 

International normalized ratio ≤ 1.3

International normalized ratio > 1.3

  
 

D-dimer ≤ 2 mg/L FEU

D-dimer > 2 mg/L FEU

  
 

Fibrinogen ≥ 100 mg/dL

Fibrinogen < 100 mg/dL

  

Neurological (0–2 points)h

 

Glasgow Coma Scale score > 10; pupils reactivei

Glasgow Coma Scale score ≤ 10i

Fixed pupils bilaterally

 

Phoenix sepsis criteria

 Sepsis

Suspected infection and Phoenix Sepsis Score ≥ 2 points

 Septic shock

Sepsis with ≥ 1 cardiovascular point(s)

  1. The Phoenix Sepsis Score may be calculated in the absence of some variables (e.g., even if lactate level is not measured and vasoactive medications are not used, a cardiovascular score can still be ascertained using blood pressure). It is expected that laboratory tests and other measurements will be obtained at the discretion of the medical team based on clinical assessment. Unmeasured variables contribute no points to the score. Ages are not adjusted for prematurity, and the criteria do not apply to birth hospitalizations, neonates whose postconceptional age is < 37 weeks, or those aged ≥ 18 years
  2. FEU, fibrinogen equivalent units, FIO2, fraction of inspired oxygen ratio, IMV invasive mechanical ventilation, INR international normalized ratio of prothrombin time, MAP mean arterial pressure, PaO2, arterial partial pressure of oxygen, SpO2, oxygen saturation measured by pulse oximetry (only SpO2 of ≤ 97%)
  3. aSpO2/FIO2 is only calculated if SpO2 is ≤ 97% or
  4. bRespiratory dysfunction of 1 point can be assessed in any patient receiving oxygen, high-flow, non-invasive positive pressure, or IMV respiratory support, and includes a PaO2/FIO2 ratio of < 200 and SpO2/FIO2 ratio of < 220 in children who are not receiving IMV. For children receiving IMV with a PaO2/FIO2 ratio of < 200 and SpO2/FIO2 ratio of < 220, see the criteria for 2 and 3 points
  5. cVasoactive medications include any dose of epinephrine, norepinephrine, dopamine, dobutamine, milrinone, and/or vasopressin (for shock)
  6. dLactate reference range between 0.5 and 2.2 mmol/L. Lactate can be arterial or venous
  7. eAge is not adjusted for prematurity, and the criteria do not apply to birth hospitalizations, children whose postconceptional age is < 37 weeks, or those aged ≥ 18 years
  8. fUse measured MAP preferentially (invasive arterial if available or non-invasive oscillometry), and if measured MAP is not available, a calculated MAP (1/3 × systolic + 2/3 × diastolic) may be used as an alternative
  9. gCoagulation variable reference ranges: platelets, 150–450 × 103/μL; D-dimer, < 0.5 mg/L FEU; fibrinogen, 180–410 mg/dL. The INR reference range is based on the local reference prothrombin time
  10. hNeurological dysfunction sub score was pragmatically validated in both sedated and non-sedated patients, and those receiving or not receiving IMV support
  11. iThe Glasgow Coma Scale score measures the level of consciousness based on verbal, eye, and motor response (range, 3–15, with a higher score indicating better neurological function)
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Journal of Intensive Care

ISSN: 2052-0492