What does sepsis mean?
The most recent definition from international consensus states that sepsis is: “Life-threatening organ dysfunction caused by a dysregulated host response to infection”. In simpler terms, this means that sometimes, when someone has a very bad infection, their body’s response to that infection makes them extremely unwell, to the extent that other organs stop working as well as they should.
How is sepsis diagnosed?
The signs of sepsis are general and systemic, regardless of where the infection started (e.g. chest or urine infection):
- A temperature that is particularly high or low (>38oC or <36oC)
- High heart rate (>90/min)
- High respiratory rate (>20/min)
- Very high or very low white blood cell count (>12,000/mm3 or <4,000/mm3)
However, one of these signs alone is not sufficient to indicate that someone has become septic. They are used in combination with other signs of organ dysfunction and clinical judgement for diagnosis.
When a patient is very unwell in hospital, they are monitored frequently using a ‘NEWS’ (National Early Warning) score. This is based on their observations such as heart rate, temperature and blood pressure, and can be used to give healthcare professionals an idea of how unwell someone is. This score is commonly used to help identify sepsis in patients as early as possible, allowing for earlier initiation of treatment.
Why is sepsis so serious?
In 2010, 5.1% of deaths in England were confirmed to be associated with sepsis. Additionally, there has been a steady rise in the incidence of sepsis since then, with an increase of over 20,000 cases between 2011 and 2014, estimating 37,000 deaths a year., However in some cases, particularly in patients who have a higher risk of developing sepsis, death can be prevented with earlier recognition and commencement of treatment; it is estimated that up to 10,000 deaths per year due to sepsis could be prevented.
What happens when someone has sepsis?
When sepsis is identified in a patient, there are clear guidelines on how to proceed, commonly known within the healthcare system as the ‘sepsis 6 bundles’. Following a recent campaign to raise awareness of sepsis and these guidelines, studies have shown that, whilst the number of sepsis cases remained unchanged, there was both a significant decrease in severity of intensive care admissions due to sepsis and an overall decrease in deaths. A 2011 study showed that this bundle was even linked to a 50% reduction in sepsis-related deaths.
The ‘sepsis 6’ bundle itself is as follows:
On the identification of sepsis in a patient, the following should be initiated with 1 hour:
- Give oxygen
- Give IV antibiotics
- Give IV fluids
- Take blood cultures
- Measure lactate level
- Monitor urine output
These guidelines are derived from the 2008 campaign: ‘Surviving sepsis’,[ix] and are now recognised internationally.
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Final year medical student, Kings College London