Overview: What is sepsis?
If bacteria, fungi or viruses attack the body, the body’s own defenses become active and react to this with an inflammation – for example in the case of pneumonia, a urinary tract infection or an inflammation of the abdomen.
Initially, only the affected area of the body becomes inflamed. Sepsis occurs when pathogens overcome local defense mechanisms of the immune system and spread throughout the organism via the bloodstream. The immune system reacts to this with inflammation throughout the body. So, in sepsis, the body attacks its own organs in the fight against infection. As a result, the blood clots and the cells no longer receive oxygen. If the bacteria attack other organs or parts of the body, they can fail or die in the worst case.
According to the current medical definition, sepsis is a life-threatening organ dysfunction caused by infection with consequent inflammatory response of the body.
Colloquially, sepsis is also referred to as “blood poisoning”. However, this term is outdated and medically incorrect because the blood is not “poisoned.” Rather, germs spread through the blood vessels in the body.
Sepsis – frequency and age
According to the German Sepsis Aid, around 1.5 million people worldwide contract sepsis every year, and around one third die as a result. There are about 550,000 cases of the disease in Europe each year. The frequency increases with age, and even children can be affected.
Sepsis: Causes and risk factors
Basically, any infection can develop into sepsis. The most common causes are
- Urinary tract infections,
- Inflammation in the abdomen,
- Wound infections and
Normally, the body fights pathogens before they threaten the entire organism. Sepsis occurs when the defense system can no longer perform these tasks properly. As a result, the pathogens are not fought, but overcome the local defense mechanisms and spread throughout the body via the bloodstream.
People with diseases that weaken the immune system are particularly at risk of developing sepsis. These include
- Cancer sufferers undergoing chemotherapy,
- Patients on immune-inhibiting therapy,
- chronic kidney and liver patients as well as
- Alcohol and drug abusers.
The following symptoms are the main signs of sepsis:
- Sudden clouding of consciousness (confusion or drowsiness)
- Low blood pressure
- Accelerated breathing (to more than 22 breaths per minute)
In addition, a strong feeling of illness, similar to the flu, may develop. In some cases, sepsis is also manifested by hypothermia (below 36 degrees Celsius) or fever and chills.
These complaints can also be present in other, more harmless diseases. If the symptoms occur in a severe form in conjunction with an infection or in immunocompromised patients, you should think of a possible sepsis.
If you have an infection and observe the symptoms described above, you should immediately go to a hospital or call the emergency services. Since sepsis can be life-threatening, rapid action is required.
Important to know: Contrary to popular belief, a red streak that spreads toward the heart is not a sign of sepsis. Rather, it is an inflammation of the lymphatic channels (lymphangitis), which indicates local inflammation. Although it can lead to sepsis. However, this is very rarely the case.
Sepsis: Diagnosis with us
Being able to recognize sepsis quickly and safely can be vital. Until a few years ago, physicians made the diagnosis according to the SIRS criteria. SIRS stands for “systemic inflammatory response syndrome.” This can be used to assess the strength of the inflammatory response. However, this often took too long. In addition, the extent of the inflammation does not necessarily say anything about how the affected person feels. Rather, the chances of survival depend primarily on how many organs are affected.
For this reason, a new, simpler definition of sepsis was introduced in 2016, Sepsis-3, which focuses on organ failure. The diagnosis of sepsis is made when the following three symptoms are present:
- Change of consciousness
- Low blood pressure
- Accelerated breathing
We also refer to these three diagnostic criteria as the qSOFA score. The acronym stands for “rapid sepsis-related organ failure assessment.”
After this initial assessment, we initiate intensive care emergency measures. The goal is to bring the infection under control and stabilize the individual.
We then check which organs are damaged and to what extent. For this purpose, we examine, for example, lung function, blood coagulation, kidney and liver values. Based on the results of the examination, we assess the condition of the organs on a point scale from 1 (slightly impaired) to 4 (severely impaired). All points together result in the total SOFA score. The higher the number, the more advanced the sepsis.
If we find severely decreased blood pressure and increased lactic acid (lactate) levels in the blood, these are signs of septic shock. This is the most severe form of sepsis.
Sepsis: prevention, early detection, prognosis
Sepsis occurs as a result of infection with pathogens. Infections are best prevented through hygiene. In hospitals, sepsis is one of the most common preventable causes of death. Careful hygiene is also important in doctors’ offices and places where many people are present. This means:
- Wash your hands thoroughly on a regular basis. This is especially true if you have come into contact with sick people or objects that could be colonized by pathogens.
- The following applies: Soap all palms and fingers thoroughly, then rinse carefully and dry well. Hand washing should take 20 to 30 seconds. Also, leave hand sanitizer on for at least 30 seconds to kill all germs.
- People with a weakened immune system have an increased risk of sepsis. This affects the elderly and people who have had a splenectomy. If this applies to you, you should take special care to receive all recommended vaccinations. Vaccination against pneumococci is particularly important. These can cause pneumonia – one of the most common causes of sepsis.
Course and prognosis of sepsis
The course and prognosis depend on the age, the health condition of the person affected and the trigger of the infection. Sepsis can lead to death within a few hours. Of the 1.5 million people affected worldwide, about one in three dies as a result of sepsis. Septic shock, the most severe form of the disease, is fatal for more than one in two people. If the inflammation rages in the body for a long time, the organs can be damaged and eventually fail. Therefore, the sooner the patient is treated, the greater the chances of survival.
For individuals who survive sepsis, recovery sometimes takes years. Often, the organ damage results in lifelong consequences such as paralysis if the nerves have been permanently damaged. In some cases, amputation also becomes necessary when, as a result of impaired circulation, limbs have not been supplied with sufficient oxygen and nutrients and the tissue dies. Last but not least, many sufferers deal with the psychological consequences of the life-threatening disease and develop post-traumatic stress disorder.
In the case of sepsis, rapid and targeted treatment is required to ensure the survival of the affected person. Sepsis is often accompanied by painful and distressing physical symptoms. Treatment measures such as artificial respiration can also be uncomfortable or stressful. Therefore, in some cases, we administer a sedative to the ill person or put him or her into an artificial coma.