Sepsis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]

Synonyms and keywords: sepsis syndrome; septic shock; septicemia


The international guideline committee for diagnosis of septic shock recommends obtaining appropriate cultures that may include at least two blood cultures, urine, cerebrospinal fluid, wounds, respiratory secretions, or other body fluid cultures before antimicrobial therapy is initiated. If such cultures do not cause significant delay in antibiotic administration, then other tests that may be done include blood gases, kidney function tests, platelet count, white blood cell count, blood differential, fibrin degradation products, and peripheral smear.[1][2]

2016 Surviving Sepsis Campaign International Guidelines for Diagnosis of Severe Sepsis and Septic Shock (DO NOT EDIT)[3]

1. The guideline committee recommends obtaining appropriate cultures before antimicrobial therapy is initiated if such cultures do not cause significant delay in antibiotic administration. To optimize identification of causative organisms, the committee recommends at least two blood cultures be obtained prior to antibiotics with at least one drawn percutaneously and one drawn through each vascular access device, unless the device was recently (less than 48 hours) inserted. Cultures of other sites (preferably quantitative where appropriate) such as urine, cerebrospinal fluid, wounds, respiratory secretions, or other body fluids that may be the source of infection should also be obtained before antibiotic therapy if not associated with significant delay in antibiotic administration. (Grade 1C)

2. The guideline committee recommends that imaging studies be performed promptly in attempts to confirm a potential source of infection. Sampling of potential sources of infection should occur as they are identified; however, some patients may be too unstable to warrant certain invasive procedures or transport outside of the ICU. Bedside studies, such as ultrasound, are useful in these circumstances. (Grade 1C)

Laboratory Findings

The laboratory findings of sepsis include:[1][2]

Complete blood count

  • WBC count is elevated
  • Fever without localizing signs of infection and a WBC count higher than 15,000/µL is suggestive of bacterial infection
  • WBC counts higher than 50,000/µL is associated with poor outcome.
  • Platelets number may be elevated
  • The monocyte distribution width may help diagnose sepsis[4].

Coagulation studies

Sepsis can activate complement system and initiate disseminated intravascular coagulation. In such cases, the following findings may be seen:

Complete metabolic profile

Microbiological studies

Type of Test Findings
Blood culture
  • Sample must be collected prior to initiating antibiotic therapy
  • The Surviving Sepsis Campaign recommends obtaining at least 2 blood cultures before antibiotics are administered
  • Susceptibility testing for organisms that have a high risk for resistance (eg, Pseudomonas, Proteus, Acinetobacter, Staphylococcus aureus, and predominant [moderate to heavy growth] Enterobacteriaceae) should be performed
  • Based on the result appropriate antibiotics should be started, delay in treatment is associated with poor outcomes
Urinalysis and urine culture
Gram stain of specimens
  • Immediately available test
  • 1 mL of fluid or tissue is needed
  • Cerebrospinal fluid [CSF], wound tissue, respiratory secretions are some of the fluids employed for staining.
  • Sputum sample in patients with a productive cough
  • Any abscess should be drained promptly and purulent material sent for analysis


  1. 1.0 1.1 Darmon M, Ostermann M, Cerda J, Dimopoulos MA, Forni L, Hoste E, Legrand M, Lerolle N, Rondeau E, Schneider A, Souweine B, Schetz M (2017). "Diagnostic work-up and specific causes of acute kidney injury". Intensive Care Med. doi:10.1007/s00134-017-4799-8. PMID 28444409.
  2. 2.0 2.1 Karnatovskaia LV, Festic E (2012). "Sepsis: a review for the neurohospitalist". Neurohospitalist. 2 (4): 144–53. doi:10.1177/1941874412453338. PMC 3726110. PMID 23983879.
  3. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL. "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008". Critical Care Medicine. 36 (1): 296–327. doi:10.1097/01.CCM.0000298158.12101.41. PMID 18158437. Retrieved 2012-09-16.
  4. Huang YH, Chen CJ, Shao SC, Li CH, Hsiao CH, Niu KY; et al. (2023). "Comparison of the Diagnostic Accuracies of Monocyte Distribution Width, Procalcitonin, and C-Reactive Protein for Sepsis: A Systematic Review and Meta-Analysis". Crit Care Med. doi:10.1097/CCM.0000000000005820. PMID 36877030 Check |pmid= value (help).

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