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Sepsis is the common cause of death most of us never hear much about. Because it ranks number 11 on the list of fatal conditions reported by the CDC, there aren't a lot of articles about sepsis, and it's not something many of us fear as the way we will eventually go. Sepsis is, however, very common, and while modern medicine is doing a better job of keeping sepsis and septic shock patients alive as long as they are in hospital hooked up to intravenous antibiotics, the risk of death after release from the hospital remains elevated.
What Is Sepsis?
Sepsis is a common term for three interrelated conditions:
- Sepsis occurs when the body releases chemicals into the bloodstream to fight an infection. Sepsis isn't the infection itself, but rather the reaction to the infection. These chemicals can cause fever, inflammation, swelling, and severe flu-like symptoms. Even a tiny area of infection (in the United States, most commonly a small cut on a foot or toe) can trigger sepsis.
- Systemic inflammatory response syndrome, also known as SIRS, is a more severe response to an infection. Organs operate at less than full efficiency, or the body can simply wear out with anemia (deficient red cell production) and neutropenia (deficient white blood cell production) of chronic disease making it harder and harder for the body to fight chronic infection.
- Septicemia is a bacterial infection in the bloodstream itself. In septicemia, bacteria can invade the entire body, making the inflammatory responses of sepsis and SIRS even worse.
- Septic shock occurs as the body is shutting down in response to sepsis, SIRS, and/or septicemia. Blood pressure falls, and organs shut. Septic shock is a medical emergency.
Doctors don't all agree on how to diagnose these conditions. Sepsis symptoms are are vague and can be caused by multiple condition include fever, muscle aches, shortness of breath, vomiting, redness, pain, or confusion, or any combination of these symptoms. There is a blood test for diagnosing sepsis, called the lactate test. Lactate is a chemical that cells make when they aren't getting enough oxygen because inflammation is interfering with blood circulation.
However, in most hospitals in the US, the phlebotomist who takes most blood samples doesn't take the lactate sample. That's usually done by a respiratory therapist. Moreover, if the phlebotomist takes the lactate sample and transfers it to the respiratory therapist without putting the vial of blood on ice, lactate in the sample breaks down and the laboratory values will be artificially low. When doctors are making a diagnosis of exclusion, looking for any explanation except sepsis, bad laboratory technique can result in missed diagnosis and delayed treatment.
Just How Deadly Is Sepsis?
In the United States, severe sepsis and septic shock kill about 28 percent of all people hospitalized for them. The death rate for African-Americans is over 50 percent. In the European Union, death occurs in about 41 percent of cases. In Australia and New Zealand, the mortality rate is about 18 percent during a 28-day stay in the hospital for treatment.
The increased risk of death doesn't go away, however, when sepsis patients are released from the hospital. Even two years later, even for patients who don't have other health problems, there is a persistently elevated risk of death.