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Cardiovascular system
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Despite the infusion of ≥40 mL/kg of fluid for 1 hour, presentation of:
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▪ Hypotension
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▪ Use of vascular inotropic drugs to maintain blood pressure
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▪ Any two of the following conditions: metabolic acidosis, high serum lactate level, oliguria, prolonged capillary refill time (CRT), or central/peripheral temperature discrepancy
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Respiratory system
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▪ PaO2/FiO2 ratio < 300
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▪ PaCO2 > 65 Torr or increase from the standard value by 20 Torr
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▪ ≥ 92% SpO2 despite maintenance of FiO2 > 0.5
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▪ Need for mechanical ventilation requiring tracheal intubation, or noninvasive positive pressure ventilation
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Nervous system
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▪ Score of ≤11 on the Glasgow Coma Scale (GCS)
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▪ Acute changes in state of consciousness (fall of ≥3 on the GCS)
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Coagulatory function
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▪ Platelet count under 80,000/μL or 50% decrease in 3-day peak platelet count
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▪ Prothrombin time-international normalized ratio (PT-INR) > 2
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Renal function
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▪ Two-fold or higher serum creatinine value compared with the normal upper limit creatinine value applicable to the age group or two-fold increase from the typical creatinine value
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Hepatic function
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▪ Total bilirubin ≥ 4 mg/dL
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▪ Two-fold or higher alanine aminotransferase (ALT) level compared to the normal upper limit applicable to the age group
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