Crisis of sepsis

A dysregulated response of the immune system, sepsis can be life-threatening as it can lead to multiple organ failure, and sometimes even death, warns Dr Gourishankar Reddy

Sepsis is the spread of infection in the entire body. But the actual definition states sepsis is a life-threatening organ dysfunction secondary to a dysregulated host response to infection.

The human body handles any infection by mounting the immune response according to the type and extent of the infection. If a significant number of factors suitable for the occurrence of sepsis converge in a certain scenario, then the complex machinery of the host’s immune system gives an appropriate response to fight that organism causing infection. It is sometimes referred to as SIRS (systemic inflammatory response syndrome). When the same immune response overshoots to a dysregulated response, it may be called sepsis. This dysregulated response of the immune system is like a directionless army finding it difficult to tell a difference between a friend and a foe.

Whilst trying to hit an infective organism, dysregulated immune response ends up damaging the patient’s own organs. That leads to multiple organ failure, and sometimes even death. Sepsis needs to be addressed as early as possible. Hence, a systematic assessment of its impact and methodological corrective actions from an emergency physician and critical care expert is a must.

The infection is most likely to affect those who have weak immune systems. The most common causes of the weakened immune system are diseases like diabetes, cancer, and kidney disease, to name a few. That’s why ensuring well-being for preventing any such illnesses is necessary to reduce infection and sepsis. Various infections that can cause sepsis are respiratory infections like pneumonia, urinary tract infection, abdominal infections, meningitis, and infective traumatic wounds of limbs etc.

The general signs and symptoms include fever or hypothermia, fatigue, altered mental status, extreme variations in heart rate or blood pressure etc. Whether a particular fever has reached the phase of sepsis is usually diagnosed with a combination of clinical acumen, lab tests and clinical scoring. The use of clinical scores such as SIRS and SOFA (sequential organ failure assessment) are indispensable tools for quantifying and monitoring the extent of damage induced by sepsis.

When should sepsis suspicion be raised?

If there is an infected wound, then that’s not likely to be sepsis. If the infected wound leads to fever and fatigue, low blood pressure, and altered sensorium, especially in elderly patients, then it might be sepsis.

If a frail elderly individual looks more confused and drowsy than usual, then he is more likely to be in sepsis than in any other condition even if he has no fever. If a baby does not feed well, is feverish and more irritable than usual, infection and sepsis can be suspected.

So, infection by some organisms is the reason for a response called sepsis.

Various modalities can be used to diagnose sepsis. A detailed history of
illness, symptoms and signs associated, blood investigations including cultures, imaging and ultrasound scans, a few biomarkers etc., can be used to diagnose infection and sepsis.

Various scoring systems have been developed that aid a physician in not only diagnosing but also staging the severity of sepsis.

Adequate vaccination if available, preventive measures, and hygiene help in preventing infections to become causation. For preventing any deterioration of health due to sepsis, it is important to identify the subtle signs and symptoms of infection/illness and report to your doctor because timely identification and intervention may avoid complications and even fatalities.

Immediate source control, early appropriate antibiotics, and early resuscitation are keystones for management. Managing complicated sepsis with low blood pressure, and multiorgan failure needs an intensive care unit or critical care set up with highly trained and skilled doctors and nursing staff. Though most patients recover, the mortality rate due to sepsis ranges from 10 to 30%.

(The author is head of MICU at a leading chain of hospitals in Bengaluru.)