Sepsis: What You Need to Know
The mere mention of the word “sepsis” is enough to send a chill down a patient’s back — and for good reason. The life-threatening diagnosis is far more common than most people know and also frighteningly fatal.
“The scary thing about sepsis is that it has a high mortality rate – over 10%,” says Christopher Mallow, M.D., pulmonologist and critical care specialist for the University of Miami Health System. “If left untreated or if the individual has risk factors, that mortality rate is much higher.”
What is sepsis?
Sepsis is an extreme reaction of the body to an infection. As the body fights this infection, it triggers a dangerous chain reaction in which the immune system reverses course by stopping its fight against the infection and instead damaging normal tissue, including organs. This leads to extensive inflammation and, in severe cases, blood clots that eventually reduce blood flow to organs, causing organ damage and even organ failure.
This is called septic shock, and as many as 40% of patients die from this.
Anyone can be diagnosed with sepsis, but there are certain groups that are at a higher risk. These include older adults (over 65 years old), immunocompromised individuals and people with medical conditions such as obesity, diabetes, cancer and kidney disease.
Almost 2 million cases of sepsis are diagnosed in a typical year, and the U.S. Centers for Disease Control and Prevention reports that 1 in 3 people who die in a hospital had sepsis during the hospitalization. In one study, recently published in JAMA Network Open, researchers called for sepsis to be labeled an epidemic and said that the condition is probably underdiagnosed in hospitals.
In August, the CDC launched the Hospital Sepsis Program Core Elements “to support all U.S. hospitals in ensuring effective teams and resources are in place to be able to quickly identify sepsis and save more lives.”
At UHealth, the staff is trained to recognize early symptoms by assessing patients for two or more criteria of Systemic Inflammatory Response Syndrome (SIRS).
These symptoms are:
- body temperature over 38 or under 36 degrees Celsius
- heart rate greater than 90 beats/minute
- respiratory rate greater than 20 breaths/minute (or partial pressure of CO2 less than 32 mmHg)
- a leukocyte (white blood cell) count greater than 12000 or less than 4000 /microliters
In addition, nurses and other clinicians look for infection-induced organ dysfunction as a sign of severe sepsis. The vigilance is warranted, Dr. Mallow says.
“Early recognition leads to early treatment, which results in better outcomes,” he adds.
However, it’s important to note that the overwhelming majority of hospital patients diagnosed with sepsis — as many as 87% — already have sepsis when they arrive at the hospital, according to the CDC. That’s why it’s important for people, particularly those at higher risk, to be vigilant about sepsis’s causes and telltale symptoms.
Most sepsis cases start with a bacterial, fungal, viral or parasitic infection.
Common infection sites include:
- the respiratory system (especially during pneumonia)
- urinary tract (especially with a catheter)
- gallbladder, liver or abdominal infections
- skin infections where bacteria enter the skin through wounds or other openings
What are the symptoms of sepsis?
Because sepsis can affect different parts of the body, its symptoms can be just as varied.
- low energy
- low blood pressure
- fast heart rate
- confusion or agitation
- rapid breathing or shortness of breath
- pain or discomfort
In the case of septicemia (blood poisoning), a patient may develop a sepsis skin rash.
If you’re fighting an infection and showing any of these signs, seek immediate medical attention.
“The inflammatory response can spread throughout the body quickly,” Dr. Mallow explains.
There are several ways to diagnose sepsis, from lab tests to physical exams, and there are also several ways to treat it, including antibiotics, IV fluids, medications to keep blood pressure steady and, in the case of organ failure, dialysis or mechanical ventilation. The key is immediate treatment.
While the sepsis mortality rate has been decreasing with improved diagnosis and treatment, the incidence rate has been increasing for years.
Health care experts point to various explanations: an older population, a growing number of diabetes cases, and skyrocketing obesity rates. The increase doesn’t have to be inevitable, however.
“You can’t do anything about growing older,” Dr. Mallow says, “but you can certainly control other risk factors, such as diabetes and obesity. The best thing we can do [to prevent sepsis] is to manage those conditions.”
He tells patients that managing weight and diabetes is important, as is practicing good hygiene — washing hands often and keeping wounds clean. And if you’ve already had sepsis, be aware that you’re at an increased risk of developing it again.
One more suggestion: “The best thing you can do to prevent sepsis is to empower your immune system,” Dr. Mallow adds. “Get vaccinated. I can’t stress the importance of vaccines enough.”
Ana Veciana-Suarez is a regular contributor to the University of Miami Health System. She is a renowned journalist and author who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at anavecianasuarez.com or follow @AnaVeciana on Twitter.