Take the Time to Know the Signs of Sepsis

Laurel Molloy, RN, MSN, CPHQ
Administrative Director of Quality and Patient Safety

Sepsis is the body’s overwhelming and life-threatening response to infection or injury that can lead to tissue damage, organ failure, amputations, and death. In other words, it is our body’s overactive and toxic response to an infection. Just like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Our immune systems usually work to fight germs (bacteria, viruses, fungi, or parasites) to prevent infection. If an infection does occur, our immune systems will try to fight it, although medications such as antibiotics, antivirals, antifungals, and antiparasitics may be needed. Sometimes the immune system stops fighting the “invaders,” and begins to turn on itself. This is when sepsis begins. 

Some people are at higher risk of developing sepsis because they are at higher risk of contracting an infection. The very young, the very old, those with a weakened immune system, those who are malnourished, or those with several other chronic health conditions are at the highest risk.

Patients are diagnosed with sepsis when they develop signs and symptoms related to sepsis. Sepsis is not diagnosed based just on the infection itself. Signs and symptoms related to infection may include fever, increased heart rate, abnormal laboratory values, and a source of the infection. Sometimes it is difficult to know what the infection was.

Sepsis progresses to severe sepsis when there are signs and symptoms of sepsis plus worsening signs of organ dysfunction, such as difficulty breathing (problems with the lungs), low or no urine output (kidneys), abnormal liver tests (liver), and changes in mental status (brain). Nearly all patients with severe sepsis require treatment in an intensive care unit (ICU).

Septic shock is the most severe level and is diagnosed when your blood pressure drops to dangerous levels in response to an overwhelming infection. Sometimes medications are needed to help support the blood pressure in the intensive care unit.

Sepsis hospitalization in the U.S. is very costly and estimated to be $62 billion annually. This is only a portion of all sepsis-related costs since there can be substantial additional costs after discharge for many such as ongoing care, medications, doctor appointments, or missed work to promote healing.

Sepsis is the primary cause of readmission to the hospital, costing more than $3.5 billion each year.

Sepsis affects approximately 1.7 million adults in the United States each year and potentially contributes to more than 250 000 deaths (Rhee, et al., 2019). Approximately 30%-50% of patients diagnosed with severe sepsis do not survive. Up to 50% of survivors suffer from post-sepsis syndrome, making them at higher risk for long-term cognitive impairment and physical problems and more susceptible to further bouts of sepsis. Early detection and treatment are essential for survival and limiting disability for survivors.

Sepsis and Cancer

Having cancer and undergoing specific treatments, such as chemotherapy, can weaken the immune system, putting people at higher risk for developing an infection that could lead to sepsis.

Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, wound infection, or urinary tract infections.

Here are some statistics related to sepsis and cancer:

• The risk of developing sepsis is increased 10 times by the presence of any cancer.
• Cancer patients have four times the incidence of severe sepsis as did patients who do not have cancer: 4 cases per 1,000 people with cancer.
• The rate of severe sepsis in cancer patients varies with the type of cancer. Patients with hematologic (blood) tumors and solid tumors, such as colon cancer or breast cancer have higher rates of sepsis.
• Hospital length of stay and hospital costs are in cancer patients with severe sepsis than in those without severe sepsis.
• The readmission rate 30 days after hospitalization is higher after a cancer-related sepsis admission than a non-cancer-related sepsis admission.

References:

Sepsis Alliance. (2022). Retrieved from https://www.sepsis.org/sepsis-basics/what-is-sepsis/

Rhee C, Jones TM, Hamad Y, et al. Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. JAMA Netw Open. 2019;2(2):e187571. doi:10.1001/jamanetworkopen.2018.757