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 – yet 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) and 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.
| High-risk criteria – any one means emergency transfer | Moderate- to high-risk criteria – assess, then treat or refer |
|---|---|
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• Mental state: objective evidence of new altered mental state. • Respiratory: respiratory rate ≥ 25/min; or a new oxygen need (≥ 40% FiO2) to keep saturation > 92% (> 88% if chronic hypercapnic respiratory failure). • Blood pressure: systolic BP ≤ 90 mmHg, or > 40 mmHg below the person's normal. • Circulation: heart rate > 130/min; no urine for 18 hours (< 0.5 ml/kg/hour if catheterised). • Skin: mottled or ashen appearance; cyanosis of skin, lips or tongue; non-blanching petechial or purpuric rash. |
• 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. • Respiratory: respiratory rate 21–24/min. • Blood pressure: systolic BP 91–100 mmHg. • Circulation: 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). • Temperature: tympanic temperature < 36°C. • Skin: signs of potential infection – redness, swelling or discharge at a surgical site, or wound breakdown. |
Source: NICE NG253 · NG254 · NG255
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