Sepsis, a condition of blood poisoning
A patient with Sepsis will have whole body inflammation. The problem is infection. Every year almost 18 million of people get affected with sepsis. If talked about the number of patients in USA, every 3 person out of 1000 suffer from this blood poison disease and the numbers of deaths due to severe sepsis in this country are 2 lakhs per year.
Millions of people die around the world due to sepsis. The numbers of people die due to the sepsis are either ever been to hospital or ever been hospitalised. 1 to 2 persons of all hospitalizations or 25 per cent of the ICU patients are the cases for sepsis.
The most important point is it is rarely reported that this hospitalization is the most significant factor. The patients of cancer or other type of serious illness have the complications and need ICU care, but the underlying factors of morbidity and mortality are either underestimated or kept under the carpet.
A study in the year 2016 by the AHRQ (Agency for Healthcare Research and Quality), of a few states have come up with the facts that out of 100,000 patients to have visited the hospitals, 651 had to stay there / were hospitalised because of sepsis. Sepsis has been found to the 2nd most leading causes of deaths of the non-ICU patients. It is also claimed that sepsis is the 10th most common cause of life losses, heart attack being the 1st one.
The most vulnerable cases of severe sepsis are children and the elderly people. Another revealing fact brought out by the AHRQ (Agency for Healthcare Research and Quality), in the year 2016, USA patients with multiple sepsis had to be readmitted in the hospital even after their treatments in the long term planned specialised hospitals or nursing homes, because of the severity of the problems.
Another study in the following year i.e. 2016, covering 18 states of the USA had observed that sepsis is the 2nd most common reason for the readmission in the hospitals within a month’s time.
A patient’s susceptibility to infection and the developments of sepsis depend much on the various medical conditions. The common risk factors of sepsis are age, the conditions that affect the immune system of the patients, like diabetes, burns, major trauma, absence of a spleen and cancer.
Sign & symptoms of Sepsis
Common signs and symptoms of sepsis are increased heart rate, fever and confusion. The symptoms may also accord with the type of infection. The example is painful urination and cough with pneumonia. Kidney infection can also be one of the symptoms. Those who have weak immune system, young and old people will have no symptom. The body temperature of these people will be normal or low, but not high.
Neonatal sepsis, in common medical uses means blood stream infection. This onset of this problem starts at the very first month of life. The neonatal sepsis is pyelonephritis, gastroenteritis, meningitis and pneumonia. Other causes of neonatal sepsis are fungi, parasites and viruses.
Many factors are responsible for sepsis. These include the status of the host’s immune system and particular invading pathogen. If the hyper inflammatory phase is earlier, it can lead to cytokine storm
Prognosis of sepsis
As per some approximate estimate, the death rate of sepsis and sepsis shock are 20 to 35 per cent and 30 to 70 per cent respectively. The prognosis of this disease is done through lactate. This is a useful method for those patients who have one level above the 4 mmol/L; these patients’ mortality rates are 40 per cent and those patients who fall below the level 2 mmol/L; their mortality rate is below 15 per cent.
A few number of prognostic stratification are available. They are Mortality in Emergency Department Sepsis and APACHE II. The factors involved in the latter are different physiological aspects of person's age, various physiologic variables and underlying conditions that provide the estimates of severe sepsis related death risks. The underlying diseases’ severity very strongly influence the death related risks. Septic shock can strongly predict both long term and short term mortality. What we know about case fatality, it is just like culture-negative and culture-positive severe sepsis. The mortality rate attached with MEDS (Emergency Department Sepsis) is found to be simpler and is very essential in the environment of emergency department.
A few of the patients may experience huge cognitive decline on a long term basis, if severe sepsis is reported there. In case the baseline neuropsychological data is not available in most of the sepsis patients, the situation will be hard to study or to quantify.
Due to severity of sepsis, the organ functions will be poor or sometimes insufficient the blood flow will be poor. The poor blood flow will symptomize high blood lactate, low blood pressure and low urine output. Due to low blood pressure, some patients will have septic shock, which is non-improvable even after infections of good amount intravenous fluids.
Causes of sepsis
Infections trigger immune systems, causing sepsis. The causes of infections are parasites, viruses and fungi. Adrenal insufficiency, anaphylaxis, low blood volume, pulmonary embolism and heart failure are the other potential causes of the problem.
Which part of the body gets infected?
Abdominal organs, skin, urinary tract, lungs, liver and the most vital organs like brain and kidney are the most affected areas.
Who are the victims?
In most of the cases, the old and young with the poor immune system due to burns, major trauma, diabetes and cancer are the victims.
Diagnosis of sepsis
Since infection is presumed, SIRS (systematic inflammatory response syndrome) is the basis of diagnosis. Although before starting any antibiotic, blood culture is needed, but blood need not to be infected for the diagnosis. For correctly locating the position of sepsis, medical imaging is a must.
Preventive measures to be involved
Sepsis affected persons need deep vein thrombosis, pressure ulcers and stress ulcers as their preventive measures, unless other impending factor prevents the intervention. A few such patients need insulin for lightly controlling their blood sugar levels. Controversies are there in the use of corticosteroids.
The use of activated drotrecogin Alfa for treating severe sepsis cases is found to be least helpful. That is why, since 2016, it has been withdrawn from the market.
Severity of the disease
30 per cent of the sepsis patients die due to the problem. Those who have severe problem, their death rate is 50%, and 80 per cent of the patients become the victims of septic shock and die for that. Since there is no reliable data available from the developing world, world number of septic death is not known. Barring developing countries’ data, millions of people die due to this disease. In the developed world alone, 0.2 to 3 in every 1000 become the victims of sepsis in every year. And the number is about a million in the USA alone. The rates of the disease are going up. Males are more victims than their opposite sex.
Blood poisoning or septicaemia refers to the microorganisms in the blood or the toxins from them. The term is no more commonly used.
Symptoms & signs of sepsis
· Low body temperature
· Increased heart rate
· Rapid breathing
Early signs include fast heart rate, high blood sugar and decreased urination. But when sepsis is established, metabolic acidosis and confusion are the main signs. These may be accompanied with the fast breathing that leads to respiratory alkalosis, decreased systemic vascular resistance, low blood pressure, dysfunctions of blood coagulation and higher cardiac output. In case blood gets clotted, organ failure is obvious. Because of sepsis, blood pressure is sure to fall, which will follow shock. The further eventuality will be light headedness with the probability of intense bleeding or bruising.
Cause of sepsis
Infections in the lungs, the urinary tract and the abdomen are the most common causes of sepsis. Mostly infection in the lungs is responsible for 50 per cent of the septic cases. 30 to 50 per cent of the cases do not come with any definite source.
In most of the cases, bacteria are the main infectious agents, but viruses or fungi are also the next major causes for sepsis. Before a decade, gram-negative bacteria used to be the main cause of sepsis. At that time the disease was caused by staphylococci, which was responsible for 50 per cent of the sepsis cases. Fungal sepsis is responsible for 5 per cent of the septic shock cases and severe sepsis cases.
Diagnosis of sepsis
Earlier is always the better for diagnosing sepsis, so that it can be managed properly. If goal directed therapy is initiated early, it can reduce mortality to a great extent and prevent it from becoming severe.
WBC should be started within the very 1st 3 hours of its suspicion. Antibiotics should not be started until serum lactate is measured and appropriate culture is obtained. To find out causative organism, minimum 2 sets of blood cultures should be taken.
If the source of infection is suspected from others such as cerebrospinal fluid, urine, wounds, or respiratory secretions, testing them is necessary. But these tests should not delay the administration of antibiotics.
Treatments of sepsis
Antibiotics and intravenous fluids are the usual treatments of sepsis. All these treatments are done in the intensive care unit. In case of fluid replacements are not successful, medicines that can raise the blood pressure are the next alternative. In this stage, kidneys and lungs need external support system which is done by dialysis and mechanical ventilation. The treatment needs the involvement of an arterial catheter and central venous catheter. Measurements like superior vena cava oxygen saturation and cardiac output are also used in the treatment.