Sepsis

### Symptoms

Fever, cough, sneezing, sweating, sore throat, increased heart rate, low blood pressure, increased breathing rate, shortness of breath, nausea/vomiting, loss of appetite, fatigue and weakness, tiredness, dizziness or lightheadedness or vertigo, low urine output, absent or near absent urine output, severe pain, confusion, decreased level of consciousness in severe cases

### Causes

Immune response triggered by an infection

### Risk Factors

Young or old age, cancer, heart disease, diabetes, major trauma, asthma, Chronic Obstructive Pulmonary Disease, multiple myeloma, burns

### Diagnostic Method

Systemic inflammatory response syndrome (SIRS), qSOFA

### Treatments

Intravenous fluids, antimicrobials, vasopressors

### Prognosis

10 to 80% risk of death; These mortality rates (they are for a range of conditions along a spectrum: sepsis, severe sepsis, and septic shock) may be lower if treated aggressively and early, depending on the organism and disease, the patient's previous health, and the abilities of the treatment location and its staff

### Frequency

0.2–3.0 per 1,000 a year (developed world)

**Sepsis**, also known as **septicemia**, **septicaemia**, or **blood poisoning**, is a potentially life-threatening condition that arises when the body's response to infection causes injury to its own tissues and organs.

This initial stage of sepsis is followed by suppression of the immune system. Common signs and symptoms include fever, increased heart rate, increased breathing rate, and confusion. There may also be symptoms related to a specific infection, such as a cough with pneumonia, or painful urination with a kidney infection. The very young, old, and people with a weakened immune system may have no symptoms of a specific infection, and the body temperature may be low or normal instead of having a fever. Severe sepsis causes poor organ function or blood flow. The presence of low blood pressure, high blood lactate, or low urine output may suggest poor blood flow. Septic shock is low blood pressure due to sepsis that does not improve after fluid replacement.

Sepsis is caused by many organisms including bacteria, viruses and fungi. Common locations for the primary infection include the lungs, brain, urinary tract, skin, and abdominal organs. Risk factors include being very young or old, a weakened immune system from conditions such as cancer or diabetes, major trauma, and burns. Previously, a sepsis diagnosis required the presence of at least two systemic inflammatory response syndrome (SIRS) criteria in the setting of presumed infection. In 2016, a shortened sequential organ failure assessment score (SOFA score), known as the quick SOFA score (qSOFA), replaced the SIRS system of diagnosis. qSOFA criteria for sepsis include at least two of the following three: increased breathing rate, change in the level of consciousness, and low blood pressure. Sepsis guidelines recommend obtaining blood cultures before starting antibiotics; however, the diagnosis does not require the blood to be infected. Medical imaging is helpful when looking for the possible location of the infection. Other potential causes of similar signs and symptoms include anaphylaxis, adrenal insufficiency, low blood volume, heart failure, and pulmonary embolism.

Sepsis requires immediate treatment with intravenous fluids and antimicrobials. Ongoing care often continues in an intensive care unit. If an adequate trial of fluid replacement is not enough to maintain blood pressure, then the use of medications that raise blood pressure becomes necessary. Mechanical ventilation and dialysis may be needed to support the function of the lungs and kidneys, respectively. A central venous catheter and an arterial catheter may be placed for access to the bloodstream and to guide treatment. Other helpful measurements include cardiac output and superior vena cava oxygen saturation. People with sepsis need preventive measures for deep vein thrombosis, stress ulcers, and pressure ulcers unless other conditions prevent such interventions. Some people might benefit from tight control of blood sugar levels with insulin. The use of corticosteroids is controversial, with some reviews finding benefit, and others not.

Disease severity partly determines the outcome. The risk of death from sepsis is as high as 30%, while for severe sepsis it is as high as 50%, and septic shock 80%. Sepsis affected about 49 million people in 2017, with 11 million deaths (1 in 5 deaths worldwide). In the developed world, approximately 0.2 to 3 people per 1000 are affected by sepsis yearly, resulting in about a million cases per year in the United States. Rates of disease have been increasing. Some data indicate that sepsis is more common among males than females, however, other data show a greater prevalence of the disease among women. Descriptions of sepsis date back to the time of Hippocrates.

## Symptoms

In addition to symptoms related to the actual cause, people with sepsis may have a fever, low body temperature, rapid breathing, a fast heart rate, confusion, and edema. Early signs include a rapid heart rate, decreased urination, and high blood sugar. Signs of established sepsis include confusion, metabolic acidosis (which may be accompanied by a faster breathing rate that leads to respiratory alkalosis), low blood pressure due to decreased systemic vascular resistance, higher cardiac output, and disorders in blood-clotting that may lead to organ failure. Fever is the most common presenting symptom in sepsis, but fever may be absent in some people such as the elderly or those who are immunocompromised.

The drop in blood pressure seen in sepsis can cause lightheadedness and is part of the criteria for septic shock. Oxidative stress is observed in septic shock, with circulating levels of copper and vitamin C being decreased. Diastolic blood pressure falls during the early stages of sepsis, causing a widening/increasing of pulse pressure, which is the difference between the systolic and diastolic blood pressures. If sepsis becomes severe and hemodynamic compromise advances, the systolic pressure also decreases, causing a narrowing/decreasing of pulse pressure. A pulse pressure of over 70 mmHg in patients with sepsis is correlated with an increased chance of survival. A widened pulse pressure is also correlated with an increased chance that someone with sepsis will benefit from and respond to IV fluids. In severe cases, decreased level of consciousness may occur.

## Causes

Bacterial infections are one of the most common causes of sepsis. Fungal, parasitic, viral infections, and inflammations like pneumonia are also potential sepsis causes. You can get sepsis when an infection triggers a chain reaction throughout your body causing organ dysfunction.

## Treatment

Sepsis treatment needs to begin immediately. The most important concern in sepsis protocol is a quick diagnosis and prompt treatment. If your provider diagnoses you with sepsis, they’ll usually place you in the intensive care unit (ICU) of the hospital for special treatment. You may receive the following treatment for sepsis:

* Antibiotics: You’ll receive antibiotics if you have a bacterial infection.
* IV (intravenous) fluids: You’ll need fluids to maintain blood flow to your organs and prevent your blood pressure from dropping too low.
* Vasopressor medications: Vasopressors tighten blood vessels. In some cases, you may need them to reach an adequate blood pressure.
* Appropriate supportive care: If organ failures occur, you’ll need other sepsis treatments such as dialysis for kidney failure or mechanical ventilation for respiratory failure.
* Surgery: You may need surgery to remove damaged tissue.