What is sepsis?
Sepsis is one of the world’s most common deadly diseases but it’s one of the least recognised. Sepsis remains the primary cause of death from infection despite all the advances in modern medicine over the last 50 years, including vaccines, antibiotics, and intensive care.
Put simply, it’s a life threatening illness that arises when the human body’s response to an infection spirals rapidly out of control and makes it injure its own tissues and organs. Even with modern intensive medical care, Sepsis can quickly lead to shock, multiple organ failure and death. But there is good evidence that prompt, appropriate treatment saves lives.
Is it like some newfangled name for ‘blood poisoning’, then?
Sepsis is not new, but because it often happens in people with an existing infection or condition, it is often under-diagnosed or mislabeled as something else. This prevents us from knowing its true extent.
In the past, it’s been known by various other names like “blood poisoning”, “severe infection” or “septicaemia”, but since 1992 doctors and scientists have renamed it Sepsis. Subsequently they began campaigning worldwide to raise awareness, prioritise new treatments and try and work out the scale of the problem.
By more carefully defining the words used to label diagnoses on people’s medical records, doctors can more accurately record how many people are affected, compare patients and work out how best to help in future cases.
Doctors actually define sepsis into three subgroups according to how bad it is:
- Severe Sepsis and
- Septic Shock.
Things have got better, but despite all that hard work, Sepsis still remains under-recognised even by health professionals. So agencies like the NHS and FEAT are campaigning to spread awareness about the importance of early recognition and treatment.
Why is it important?
Sepsis is a global problem. Between 20–30 million cases occur each year, and the incidence is rising. Worldwide, sepsis accounts for roughly one third to one half of all deaths. Sepsis causes more deaths than prostate cancer, breast cancer and HIV/AIDS combined. It is likely that the process of sepsis is actually responsible for most of the deaths associated with HIV/AIDS, malaria, pneumonia and other infections acquired in the community, in healthcare settings or through traumatic injuries.
Although sepsis kills indiscriminately of geography, in the developing world the problem is much worse. There it accounts for 60-80% of annual childhood deaths: that’s more than 6 million newborns and children yearly. It is also responsible for more than 100,000 cases of maternal sepsis in women who are pregnant or have just given birth.
In the developed countries, the incidence of sepsis is increasing dramatically too, mainly due to the ageing population and despite the advantages of modern medicine including vaccines, antibiotics and intensive care. Add to that the fact that people coming into hospital in developed countries tend to be sicker and more complicated and you can see how the number of people developing sepsis in hospital after surgery trebled from 1997 to 2006.
Although many people get sepsis when they already have another health problem, studies suggest that 20- 40% of sepsis patients that require treatment in the Intensive Care Unit developed their sepsis outside of hospital. Hospital admissions for sepsis have more than doubled over the last 10 years and have overtaken those for heart attacks in the USA.
All of this equates to around 1,000 people worldwide dying of sepsis daily. That’s like three full airliners crashing every day.
In the UK alone, it’s estimated that 37,000 people per year die from sepsis. That’s more people than die of lung cancer, and more than the total deaths from breast cancer and bowel cancer combined. And unlike those diseases, we don’t have a clear picture of risk factors.
But what’s that got to do with me?
Sepsis is indiscriminate, it is one of the few remaining illnesses in developed countries that can kill a healthy adult in a matter of hours.
And it’s not just about fatalities. Sepsis is a life-changing illness. In studies, patients who survived sepsis have double the risk of death in the following 5 years compared with hospitalised controls. Those fortunate patients who do survive sepsis are often left with significant physical, psychological and social complications ranging from chronic pain, post-traumatic stress disorder, and unemployment to scars, limb amputations, seizures, kidney impairment and bowel problems. It could happen to your brother, sister, partner, child, parent, friend.
The costs related to the long-term consequences of sepsis are unknown. In Europe, it has been estimated that a typical episode of sepsis costs healthcare services approximately 25,000 Euros. Given the considerable loss of productive life years the true human costs of sepsis are undoubtedly enormous.
The Signs and Symptoms of Sepsis
If you have more than one of the following symptoms get immediate medical attention. Sepsis is a medical emergency, but early recognition and treatment does save lives.
- Very high or low temperature
- Difficulty breathing
- Rapid heart beat
- Low blood pressure or weak pulse
- Change in behaviour: Slurred speech, Confusion, Drowsiness or loss of consciousness
- Uncontrollable shivering
- Changes in skin colour (e.g. very cold or very flushed hands and feet)
- Reduction in the amount of urine passed
- Recent or current infection (e.g. a skin, wound, urine or chest infection)
- A co-existing condition that makes you at risk (e.g. pregnancy, cancer, chronic illness, immunosuppression)
Why the hurry?
If sepsis is treated aggressively within the first hour,“The Golden Hour”, medical evidence has shown that the risk of death is halved and survival rates can be more than 80%.
This treatment is basically the rapid initiation of simple, timely interventions including antimicrobials, intravenous fluids and targeted treatment to correct shock and restore a patient’s circulation. Patients who have suspected sepsis should be referred immediately to an appropriate facility. As well as the better survival, early sepsis recognition and treatment has been shown to be cost effective too:it reduces hospital and Intensive Care Unit bed days for patients and so saves the taxpayer money. Unfortunately, sepsis is still mostly overlooked and recognised too late.
But why is sepsis diagnosis often delayed?
Unfortunately, the clinical symptoms and laboratory signs that are currently used to diagnose sepsis, like raised temperature, increased pulse or breathing rate, or white blood cell count are quite non-specific. In children, the signs and symptoms may be subtle and deterioration rapid.
As already mentioned, sepsis is under-recognised and poorly understood due to persistent confusion about its definition among patients and healthcare providers, the lack of documentation of sepsis as a cause of death on death certificates, inadequate diagnostic tools, and inconsistent use of standardised clinical guidelines to treat sepsis.
Know the signs and symptoms and seek help immediately. Help us to raise awareness and recognition of sepsis at all levels and to develop new approaches to STOP SEPSIS NOW.
Find out more
Much of the above information is taken from the World Sepsis Day Fact Sheet 2013. For more information including references please go to http://www.world-sepsis-day.org