On June 3, 2016, boxing legend Muhammad Ali died after a short hospitalization for a respiratory ailment. He had previous hospitalizations but this one progressed to sepsis and led to his death from septic shock.
Sepsis kills more than 258,000 Americans each year and leaves thousands of survivors with life-changing after effects. According to the CDC, there are over one million cases of sepsis each year, and it is the ninth leading cause of disease-related deaths. The number of cases of sepsis each year has been going up in the United States. Sepsis is a common complication of people hospitalized for other reasons.
Sepsis is the body’s overwhelming and life-threatening response to infection, which can lead to tissue damage, organ failure, and death. Immune chemicals released into the blood to combat the infection trigger widespread inflammation, which leads to blood clots and leaky vessels. This results in impaired blood flow, which damages the body’s organs by depriving them of nutrients and oxygen.
Any type of infection that is anywhere in the body can cause sepsis, including infections of the skin, lungs (such as pneumonia), urinary tract, abdomen (such as appendicitis), or another part of the body. Many different types of microbes can cause sepsis, including bacteria, fungi and viruses, but bacteria are the most common culprits. Severe cases often result from a body-wide infection that spreads through the bloodstream, but sepsis can also stem from a localized infection. Anyone can get sepsis as a bad outcome from an infection, but the risk is higher in (1) people with weakened immune systems; (2) babies and very young children; (3) elderly people; (4) people with chronic illnesses, such as diabetes, AIDS, cancer, and kidney or liver disease; and (5) people suffering from a severe burn or wound.
Many doctors view sepsis as a three-stage syndrome. First, sepsis causes fever, rapid heart rate/breathing, and an increased white blood cell count. To be diagnosed with sepsis, a patient must have a probable or confirmed infection and exhibit at least two of the following symptoms: (1) body temperature above 101 F (38.3 C) or below 96.8 F (36 C), (2) heart rate higher than 90 beats a minute, and (3) respiratory rate higher than 20 breaths a minute. As sepsis worsens, blood flow to vital organs, such as the brain, heart and kidneys, becomes impaired. Sepsis can also cause blood clots to form in organs and in arms, legs, fingers and toes — leading to varying degrees of organ failure and tissue death (gangrene).
The second stage of this three-stage syndrome is sever sepsis. Sever sepsis is when there are also signs and symptoms that indicate an organ may be failing. The diagnosis will be upgraded to severe sepsis if the patient also exhibits at least one of the following signs and symptoms: (1) significantly decreased urine output, (2) abrupt change in mental status, (3) decrease in platelet count, (4) difficulty breathing, (5) abnormal heart pumping function, and (6) abdominal pain. Immediate hospital treatment is required.
The third stage of this three-stage syndrome is septic shock. Septic shock is when a patient has severe sepsis, plus extremely low blood pressure that does not respond to fluid replacement. Immediate hospital treatment is required.
People with sepsis are usually treated in hospital intensive care units. Doctors try to quell the infection, sustain the vital organs and prevent a drop in blood pressure. The first step is often treatment with broad-spectrum antibiotics, medicines that kill many types of bacteria. Once lab tests identify the infectious agent, doctors can select medicine that specifically targets the microbe. Many patients receive oxygen and intravenous fluids to maintain normal blood oxygen levels and blood pressure. Depending on the patient’s status, other types of treatment, such as mechanical ventilation or kidney dialysis, may be necessary. Sometimes, surgery is required to clear a local site of infection. Many other drugs, including vasopressors and corticosteroids, may be used to treat sepsis or to revive those who have gone into septic shock. Despite years of research, scientists have not yet succeeded in developing a medicine that specifically targets the aggressive immune response that characterizes sepsis.
Many people who survive sepsis recover completely and their lives return to normal. But some people may experience permanent organ damage. For example, in someone who already has kidney problems, sepsis can lead to kidney failure that requires lifelong dialysis. However, older people, people who have suffered more severe sepsis, and those treated in an intensive care unit are at greatest risk of long-term problems, including suffering from post-sepsis syndrome.
Post-sepsis syndrome is the term used to describe the group of long-term problems that some people with severe sepsis experience. These problems may not become apparent for several weeks (post-sepsis), and may include such long term consequences as:
- Insomnia, difficulty getting to or staying asleep
- Nightmares, vivid hallucinations, panic attacks
- Disabling muscle and joint pains
- Decreased mental (cognitive) functioning
- Loss of self-esteem and self-belief
- Organ dysfunction (kidney failure, respiratory problems, etc.)
- Amputations (loss of limb(s))
One of the main challenges of sepsis treatment is diagnosis. By the time doctors realize a patient is septic and start treatment, it can be too late. Earlier diagnosis and treatment could have a profound effect on survival rates. Because of this, many research efforts are aimed at finding ways to recognize the onset of the condition more quickly.
Several research teams are looking for factors in the bloodstream that could signal sepsis and become the basis of a test designed to identify the condition before symptoms become severe. Some approaches analyze sepsis-related changes in the gene activity patterns within immune cells.
Other efforts are directed at determining how best to treat the syndrome and at what point treatments are most effective. One of these was a large study called Protocolized Care for Early Septic Shock (ProCESS), which examined different treatment approaches during the first six hours of care. It concluded that prompt recognition of the condition followed by the administration of intravenous fluids and antibiotics are key to survival.
See the CDC Sepsis Site
See the National Institute of General Medical Sciences’ Sepsis Fact Sheet
See the National Institute of General Medical Sciences’ announcement, “Sepsis Study Comparing Three Treatment Methods Shows Same Survival Rate”
See also Medical Law Perspectives, June 2016 Report: How Risky Is Going to the Hospital? The Dangers and Liabilities of Healthcare-Associated Infections