By P.J. Heller
It can start as a simple infection. It can end in death.
What triggers such a life-threatening condition is sepsis, the body’s extreme reaction to an infection. Without quick intervention, sepsis/septic shock can lead to tissue damage, organ failure and death.
“Sepsis is a medical emergency,” notes the Centers for Disease Control and Prevention (CDC). “Time matters.”
Dr. Steven Q. Simpson, chief medical officer of the Sepsis Alliance and professor of medicine at the University of Kansas, goes even further, labeling sepsis “a public health crisis.”
According to the non-profit Sepsis Alliance, more than 258,000 people will die each year in the U.S. from sepsis, a number that is greater than those who die from prostate, breast and lung cancer combined. More than 1.7 million people in America will develop sepsis every year.
Worldwide, sepsis affects 27 million to 30 million people annually with 7 million to 9 million deaths, one death every 3.5 seconds, reported the Global Sepsis Alliance, co-founded by the Sepsis Alliance.
Depending on the country, mortality varies between 15 percent to more than 50 percent, said the global alliance, which represents 1 million caregivers in more than 70 countries.
“A relatively healthy person can get very sick, very quickly, sometimes before they even realize they have an infection,” said the Sepsis Alliance, founded in 2007 by retired endodontist Dr. Carl Flatley, whose daughter Erin died of septic shock when she was 23 years old.
“Anyone can get sepsis,” agreed the National Institute of General Medical Sciences (NIGMS), part of the National Institutes of Health. “The people at highest risk are infants, children, older adults, and people who have serious injuries or medical problems such as diabetes, AIDS, cancer, or liver disease.”
The CDC says 80 percent of sepsis cases begin outside of the hospital. “More than 90 percent of adults and 70 percent of children who developed sepsis had a health condition that may have put them at risk,” it said.
“The problem is that sepsis quietly sneaks up on unsuspecting victims, who often think they have a severe and sudden case of the flu,” said Regina Hoffman, executive director of the Patient Safety Authority, an independent state health agency in Pennsylvania. “The symptoms can be tricky to spot.”
Sepsis can initially be hard to diagnose because some of those symptoms — fever, increased heart rate, difficulty breathing and low blood pressure — mimic other conditions. Other symptoms can include extreme pain or discomfort, confusion or disorientation, chills, or clammy or sweaty skin.
“Sepsis is a major challenge in hospitals, where it’s one of the leading causes of death,” NIGMS said. “It's also a main reason why people are readmitted to the hospital. Sepsis occurs unpredictably and can progress rapidly.”
Left unchecked, sepsis can progress to septic shock — dangerously low blood pressure and organ shutdown — which makes premature death more likely.
Well-known personalities who died due to sepsis/septic shock include Oscar-winning actress Patty Duke, boxing legend Muhammad Ali, Muppets creator Jim Henson, and Microsoft co-founder Paul Allen. Frequently, deaths are attributed to “complications” from a particular illness and not directly to sepsis.
Sepsis is the most expensive condition treated in U.S. hospitals, the Agency for Healthcare Research and Quality reported. An average hospital stay for sepsis is about $18,000, while the cost of treating sepsis patients runs anywhere from $24 billion to more than $27 billion a year, according to recent estimates.
“Sepsis treatment is expensive,” NIGMS said. “It often involves a prolonged stay in the intensive care unit and complex therapies with high costs . . . People with sepsis are two to three times more likely to be readmitted to the hospital than people with many other conditions, including heart failure, pneumonia, and chronic obstructive pulmonary disease. Readmissions due to sepsis are also more expensive than readmissions due to any of these other conditions.”
Lung, urinary tract, skin and gut infections are the most common infections linked to sepsis.
Rapid, effective sepsis treatments include giving antibiotics, maintaining blood flow to organs and treating the source of the infection, the CDC said.
“Sepsis is deadly when it’s not quickly recognized and treated,” it said.
“Doctors and nurses treat sepsis with antibiotics as soon as possible. Many patients receive oxygen and intravenous fluids to maintain blood flow and oxygen to organs. Other types of treatment, such as kidney dialysis or assisted breathing with a machine, might be necessary. Sometimes surgery is required to remove tissue damaged by the infection,” it added.
Dr. Alice Gallo De Moraes, a pulmonary and critical care medicine specialist at Mayo Clinic, said quick response to sepsis is key.
“Research has shown . . . that if treatment is started within the first few hours from the time sepsis begins, the mortality rate from sepsis falls significantly,” she said. “That makes early, aggressive treatment of sepsis crucial. If it is caught quickly, sepsis often can be managed effectively.”
Prevention methods include promptly identifying and treating infections, practicing good hygiene, keeping vaccinations current and knowing the symptoms of sepsis. Simpson, writing in Outbreak News Today, estimates that 80 percent of sepsis deaths can be prevented.
While some people recover completely from sepsis, others may have long-term issues.
“ . . . Some people, especially those with pre-existing chronic diseases, may have permanent organ damage. For example, in someone who already has impaired kidneys, sepsis can lead to kidney failure that requires lifelong dialysis,” NIGMS said. “There is also some evidence that severe sepsis disrupts a person’s immune system, making him or her more at risk for future infections. Studies have shown that people who have experienced sepsis have a higher risk of various medical conditions and death, even several years after the episode.”
Memory loss, insomnia, anxiety or depression may also be among the after-effects of sepsis, the Sepsis Alliance added.
While sepsis cases appear to be increasing, part of that may be attributable to physicians getting better at diagnosing it and the public becoming more aware of it. A May 2018 survey showed that about 65 percent of American adults had heard of sepsis, up from 44 percent four years ago. However, one-third of American adults had never heard of sepsis and only 12 percent of the more than 2,000 people surveyed were aware of sepsis symptoms and the urgent need to seek medical attention.
“The hope is that by alerting the public as well as general practitioners and other people who treat simple infections, that we can educate them about the signs and symptoms,” Chris Seymour, assistant professor of critical care and emergency medicine at University of Pittsburgh School of Medicine, told Bloomberg News.
Researchers are also working to develop devices and technologies to more easily diagnose sepsis. At the Massachusetts Institute of Technology, researchers have developed a diagnostic tool that can identify a protein that the body produces when inflammation occurs. It requires less than a drop of blood with results available within 30 minutes.
A blood test being developed over the last decade by researchers from several children’s hospitals also could eventually result in quicker and earlier treatment for sepsis.
In yet another effort, researchers at the Feinstein Institutes for Medical Research have discovered a new way to reduce sepsis inflammation. The institute is the research arm of Northwell Health, the largest healthcare provider in New York.
“We want everyone to realize that sepsis is a life-threatening medical emergency,” said Hoffman of the Patient Safety Authority. “Anyone can get an infection, and almost any infection can lead to sepsis. If you think you or a loved one might have sepsis, speak up quickly. Get to a hospital or call 911 and ask, ‘Could this be sepsis?’”
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