GPAtlas🧭 When to suspect
Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection.
• It is common and time-critical – an estimated 245,000 cases and many thousands of deaths occur in the UK each year.
• It is easy to miss, because people may have non-specific, non-localised presentations (simply "feeling very unwell") and may not have a high temperature.
The first step is a habit of mind: think "could this be sepsis?" in anyone with a known or suspected infection who looks unwell or has any new abnormality of behaviour, circulation or respiration.
In November 2025 NICE replaced the single sepsis guideline (NG51) with three guidelines:
• NG253 (people aged 16 or over)
• NG254 (under-16s)
• NG255 (pregnant or recently pregnant people)
The risk tool depends on the setting: in community and custodial settings grade risk with the NG253 criteria below; in ambulances and acute hospital or acute mental health settings (16 or over), use NEWS2 (National Early Warning Score 2).
The two core skills in primary care are to risk-stratify with a full set of observations and to never miss the high-risk patient who needs immediate transfer.
| Domain | High-risk criteria – any one means emergency transfer | Moderate- to high-risk criteria – assess, then treat or refer |
|---|---|---|
|
Mental state |
• Objective evidence of new altered mental state |
– |
|
Respiratory |
• Respiratory rate ≥ 25/min • A new oxygen need (≥ 40% fraction of inspired oxygen [FiO2]) to keep saturation > 92% (> 88% if chronic hypercapnic respiratory failure) |
• Respiratory rate 21–24/min |
|
Blood pressure |
• Systolic BP ≤ 90 mmHg, or > 40 mmHg below the person's normal |
• Systolic BP 91–100 mmHg |
|
Circulation |
• Heart rate > 130/min • No urine for 18 hours |
• Heart rate 91–130/min (100–130 in pregnancy) or new arrhythmia • No urine for 12–18 hours (0.5–1 ml/kg/hour if catheterised) |
|
Skin |
• Mottled or ashen appearance • Cyanosis of skin, lips or tongue • Non-blanching petechial or purpuric rash |
• Signs of potential infection – redness, swelling or discharge at a surgical site, or wound breakdown |
|
Temperature |
– |
• Tympanic temperature < 36°C |
|
History |
– |
• Reported new altered behaviour or mental state • Acute deterioration of functional ability • Impaired immune system (illness or drugs, including oral steroids) • Trauma, surgery or invasive procedure in the last 6 weeks |
Source: NICE NG253 · NG254 · NG255
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.