More awareness is needed for this silent, deadly threat to life
Sepsis is a life-threatening medical condition when the body launches an extreme response to an infection. Anyone can get an infection, and any infection can lead to sepsis, in which a massive chain reaction throughout the body causes an inflammation cascade that can lead to organ failure and death without timely treatment. A third of people who die in a hospital had sepsis.[1] Given this statistic, sepsis has a pervasive impact on healthcare systems worldwide, although most cases of sepsis start before a patient ends up in the hospital. Get Ahead of Sepsis is a national educational effort[2] that emphasizes the importance of early recognition, timely treatment, antibiotic efficacy, and overall prevention of infections. Let’s shed some light on the cause of sepsis, risk factors, clinical presentation, diagnosis, and treatment of this complex condition.
An infection is the early beginning of sepsis. These could be an open wound, a urinary tract infection, the common cold leading to pneumonia, or a stomach bug. Healthy individuals can fight off common infections caused by bacteria, viruses, or fungus, although it’s important to note that most people who develop sepsis have at least one underlying medical condition. If infection is not controlled in a weakened individual, the immune response becomes erratic, leading to widespread inflammation and the release of cytokines. Uncontrolled, intense inflammation can result in the biological breakdown of healthy tissues, ultimately causing organ dysfunction.
Remember we mentioned other underlying conditions? Several risk factors can make a person more susceptible to experiencing sepsis[3].
These include:
Very young or very old: Children younger than one year old and elderly persons 65 years or older are at higher risk.
Chronic illnesses: Those with chronic medical conditions, such as diabetes, lung cancer, cancer, HIV, and kidney disease typically have weakened immune systems.
Immunocompromised individuals
Hospitalization: People with recent severe illness, invasive procedures, or hospitalization can develop an infection from a medical device or a healthcare-associated infections, a common source of sepsis.
People who have survived sepsis before
Long-term antibiotic use: This can disrupt the body’s normal flora, making it difficult to fight off infections.
Drug and alcohol abuse: Abusing drugs and alcohol weakens the health defenses, while increasing one’s exposure to infection.
While these circumstances can increase someone’s risk of developing sepsis, anyone can get sepsis.
Diagnosing sepsis is challenging because it can manifest in many ways, and often, sepsis often goes unrecognized until the patient is at a highly difficult-to-treat, if not irreversible, stage of shock. Common signs include fever, low blood pressure, increased heart rate, and difficulty breathing. Other symptoms may include a weak pulse, shivering or feeling cold, confusion or disorientation, clammy skin, fatigue, weakness, and/or extreme pain. Once a patient is in the hospital, physical findings include blood cultures, tests for viral infections, elevated white blood cell count, lactate levels, and tests that check for organ damage. Healthcare professionals use these tests to determine the cause of the infection so they can use the appropriate antibiotic treatment.
Timely diagnosis is crucial for administering life-saving treatment.[4] Once the pathogen is identified, treatment strategies include surgery or drainage to eliminate the source of infection (if necessary), administration of targeted antibiotics and intravenous fluids to improve tissue hydration, adding medications that help with blood pressure and circulation, called vasopressors, as well as supportive care which can include oxygen, mechanical ventilation, renal replacement therapy, and immune therapies. Despite advances in intensive care and evidence-based guidelines, the death rate due to sepsis is still very high; those that survive septic shock often have an increased risk of death, impaired physical and mental function, amputations, mood disorders, and a low quality of life.[5]
Is there a way to prevent sepsis? Well, for those with chronic conditions, such as diabetes, lung or kidney disease, or any cancer, and for those who are immunocompromised, it’s important to have meticulous, proactive self-care and practice good hygiene. Everyone should practice good hygiene, such as washing your hands often, keeping cuts clean and covered until they’re healed, and avoiding highly populated areas if you’re not feeling well. Vaccinations can also prevent some infections. Be aware of the signs and symptoms of sepsis so that prompt medical attention can be given. If you or a loved one has an infection that’s not getting better or is getting worse, ask your healthcare professional if it could be leading to sepsis and go to an emergency room immediately.
Sepsis truly is a silent, deadly threat to life that needs greater awareness. Its devastating consequences can be lessened through quick recognition, timely diagnosis, prompt and appropriate treatment, and prevention measures. Countless lives can be saved, and the quality of healthcare will improve as the medical community learns more about the complexities of sepsis.
[1] Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion. “What is Sepsis?”, updated August 24, 2023. Available at: https://www.cdc.gov/sepsis/what-is-sepsis.html. [2] Available https://www.cdc.gov/sepsis/education/index.html [3] Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013; 369(9): 840-851. Available at: https://www.nejm.org/doi/10.1056/NEJMra1208623. [4] Srzic I, Nesek AV, Tunjic Pejak D. Sepsis definition: What’s new in the treatment guidelines? Acta Clin Croat. 2022; 61(Suppl 1); 67-72. [5] Angus DC, Carlet J. Surviving intensive care: a report from the 2002 Brussels Roundtable. Int Care Med. 2003; 29:368-377.