Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs. Sepsis leads to shock, multiple organ failure and death especially if not recognized early and treated promptly. Therefore, it is critical to quickly check for signs and symptoms of sepsis in order to initiate rapid treatment.
What is sepsis?
Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when chemicals released into the bloodstream to fight the infection trigger inflammatory responses throughout the body. This inflammation can trigger a cascade of changes that can damage multiple organ systems, causing them to fail.
Some key facts about sepsis:
- Sepsis is caused by the body’s immune response to an infection, not by the infection itself.
- It can arise from any type of infection, including bacterial, viral, fungal or parasitic infections.
- Sepsis leads to septic shock if not treated quickly. Septic shock involves dangerously low blood pressure that prevents organs from getting enough blood.
- Sepsis is a major cause of mortality worldwide, leading to around 11 million deaths per year.
What causes sepsis?
Sepsis occurs when an existing infection triggers a chain reaction of inflammation throughout the body. Almost any type of infection can lead to sepsis.
Most often, the infections that cause sepsis are bacterial infections. The most common sites of these infections include:
- Lungs (pneumonia)
- Abdomen (appendicitis, diverticulitis)
- Urinary tract
- Skin and soft tissue (cellulitis)
However, sepsis can also result from viral infections, including COVID-19, as well as from fungal and parasitic infections.
In sepsis, the infection triggers the immune system to release chemicals into the blood to fight the infection. However, this exaggerated immune response begins to cause widespread inflammation that can damage tissues and organs.
Who is at risk for sepsis?
Certain people are at higher risk of sepsis due to factors that affect their vulnerability to infection or the body’s immune response:
- Infants and young children
- Older adults
- People with chronic illnesses like diabetes, cancer, kidney disease, HIV
- Hospital patients, especially ICU patients
- People with weakened immune systems
- Patients who have had severe injuries or burns
- Recent surgery patients
- People taking medications that suppress the immune system
However, sepsis can affect anyone who has an infection, regardless of age, sex or health status.
What are the symptoms of sepsis?
The signs and symptoms of sepsis result from the widespread inflammation and blood clotting that occurs in response to the infection. Symptoms can include:
- Fever above 101°F (38°C) or below 96.8°F (36°C)
- Heart rate higher than 90 beats per minute
- Breathing rate higher than 20 breaths per minute
- Confusion or delirium
- Chills due to fever
Other possible symptoms include:
- Clammy or sweaty skin
- Extreme pain or discomfort
- Pale or discolored skin
- Sleepiness, difficulty waking up, lethargy
- Low urine output
When sepsis progresses to septic shock, symptoms may include:
- Dizziness or fainting
- Difficulty breathing
- Nausea and vomiting
- Cold, clammy arms and legs
- Pale or mottled skin
- Weak pulse
- Low blood pressure
How is sepsis diagnosed?
To diagnose sepsis, doctors will:
- Check for signs of infection, like cough, urinary symptoms, skin lesions.
- Identify any infection sites, like the lungs, abdomen, or urinary tract.
- Order blood tests to check for signs of infection, like high white blood cell count.
- Check for organ dysfunction through tests like kidney function tests, liver enzymes, coagulation studies.
- Measure sepsis biomarkers like procalcitonin or lactate levels.
- Do imaging tests like x-rays, CT scans to locate infection sources.
- Culture blood, urine, sputum to identify infectious organisms.
Doctors may use various sepsis scoring systems to clinically assess patients and determine sepsis severity, such as:
- SIRS criteria – Systemic Inflammatory Response Syndrome criteria
- qSOFA score – Quick Sequential Organ Failure Assessment
- SOFA score – Sequential Organ Failure Assessment
These scoring systems check for clinical parameters like fever, respiratory rate, blood pressure, mental status changes and lab markers associated with sepsis prognosis.
Sepsis screening in hospitals
Hospitals have protocols to screen patients at risk of sepsis, especially in emergency departments and intensive care units (ICUs). Screening helps identify patients with possible sepsis who require rapid diagnosis and treatment.
Sepsis screening typically involves checking for:
- Documented or suspected infection
- Abnormal temperature (fever or hypothermia)
- Tachycardia (high heart rate)
- Tachypnea (high respiratory rate)
- Altered mental status
Patients with positive screens undergo urgent sepsis evaluation and management.
How is sepsis treated?
The mainstay of sepsis treatment involves:
- IV antibiotics – Broad-spectrum antibiotics are given immediately to treat the underlying infection.
- IV fluids – Fluids help improve blood pressure and perfuse organs.
- Vasopressors – Medications like norepinephrine help increase blood pressure in septic shock.
- Treatment of organ dysfunction – This may involve oxygen, dialysis, etc.
Doctors also:
- Give medications like acetaminophen to control fever.
- Provide pain management and compassionate end-of-life care if needed.
- Look for infection source control, like draining abscesses.
The key priority is to start antibiotics and fluid resuscitation immediately in sepsis. Even just a 1 hour delay in treatment can drastically reduce survival.
What is the outlook for sepsis patients?
When recognized and treated early, the majority of sepsis patients survive. However, sepsis carries a high risk of complications and death:
- Around 25-30% of sepsis patients die.
- Death rate is higher in septic shock (40-50%).
- Elderly patients have a higher risk of dying from sepsis.
- Sepsis is more likely to be fatal in patients with chronic illnesses.
- Early treatment greatly improves survival in sepsis.
Survivors of sepsis may experience long-term effects like:
- Physical disability or muscle weakness
- Amputations from damaged tissue
- Neurocognitive dysfunction
- Post-traumatic stress disorder (PTSD)
- Higher risk of further infections due to immune suppression
How can sepsis be prevented?
Good infection control and prevention practices help reduce sepsis risk. Steps for sepsis prevention include:
- Practicing hand hygiene and respiratory etiquette.
- Getting recommended vaccines like flu, pneumonia and COVID-19 vaccines.
- Managing chronic illnesses like diabetes to prevent infections.
- Taking preventive antibiotics before procedures if at higher risk of infection.
- Practicing safe sex and injection practices to prevent infections.
- Completing prescribed courses of antibiotics to fully treat infections.
In hospital settings, measures to prevent healthcare-associated infections like catheter-related urinary tract infections or surgical site infections can help reduce sepsis incidence.
Conclusion
Sepsis is a potentially fatal condition arising from the body’s dysregulated response to infection. It is important to promptly check for signs and symptoms of sepsis like fever, rapid breathing and heart rate, confusion and organ dysfunction in patients with suspected infection. Sepsis requires rapid diagnosis and immediate treatment with IV fluids, antibiotics and vasopressors to boost survival. Prevention through vaccination, infection control and chronic disease management is also key to reducing sepsis risk. Increased awareness and vigilance for sepsis is critical to enable early recognition and live-saving treatment of this life-threatening complication.