Sepsis, The Disease That Won't Go Away

Sepsis is the one common cause of death that 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 medical conditions, all of which are dangerous:

• 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 blood cell production) and neutropenia (deficient white blood cell production) of chronic disease, making it much 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, in cases of septic shock. Septic shock is a medical emergency as the condition can easily result in death if left untreated.

Doctors don't all agree on how to diagnose these related conditions. Sepsis symptoms are are vague and can be caused by multiple conditions. The possible symptoms of sepsis 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.

READ What Is Sepsis And Why Is It So Deadly?

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, the 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 a 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 the 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 all sepsis 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 after surviving sepsis.

Even After Surviving Sepsis Patients Need Long-Term Care

Even when aggressive treatment beats the infection and hospital care stops systemic inflammation, sepsis patients are not out of the woods. Most people who survive sepsis have to go back to the hospital for treatment of severe inflammation one or more times during next year.

• "Mild to moderate" sepsis patients have to spend, on average, 16 days in the hospital in the first year after successful treatment.
• "Severe" sepsis patients have to spend, on average, 38 days in the hospital in the first year after successful treatment.

Moreover, the risk of death of successfully treated sepsis patients remains higher than otherwise expected for at least two years. Over 45 percent of people of are treated for sepsis and discharged from the hospital will die in the next two years. No matter what the reason they are admitted to the hospital (heart attack, cancer, or injury for example), they are 20 percent more likely to die of that condition than someone who has not had sepsis. They are also more likely to die than people who suffer inflammatory conditions not caused by infection.

READ Sepsis: What You Need To Know

What can sepsis patients do to stay alive? There are things that doctors just aren't taught to think about.

• When you have been in bed with sepsis for a long time, your muscles get weak. As you feel better and start getting around more, not all of your muscles recover at the same rate. You need to be careful to avoid falls for a long time after your hospital stay. Even a year out, the more mobile you become, at least at first, the more accident-prone you become. Falling flat on your face on concrete, for example, can be just as serious as sepsis.
• IV antibiotics devastate the probiotic bacteria in your digestive tract. You almost certainly will be told to take probiotic supplements to restore them (and if you aren't, you should ask why). However, no supplement replaces all of your normal probiotic bacteria. As a result, you are likely to have problems with constipation (because there aren't enough bacteria in your gut to form stool, which is 1/3 bacteria) and diarrhea (because the new bacteria you are getting from your supplements fight the bacteria that survived antibiotic treatment). You will almost certainly need to be careful not to overeat (don't celebrate your freedom from hospital food with excess), and you may find you are suddenly sensitive to wheat, meat, tomatoes, citrus, coffee, pineapple, tropical fruits, and/or fish. Eat sparingly until you know you can tolerate old foods.
• Chronic infections tend to "wear out" your immune system so that you become prone to different chronic infections. This is not necessarily a life-long problem. In time, usually after a year or two, your body's ability to make red and white blood cells may recover. In the meantime it is important to avoid new infections by washing your hands frequently, by washing your clothes and bed linens frequently, and by getting any immunizations you may need, or avoiding public contact during flu and colds season.

If you have not had sepsis, you can take steps to reduce your risk of developing it. 

Getting your regular flu shots, pneumonia shots, and other boosters that help prevent infections is a good start. If you get a small scrape or cut, disinfect it regularly while it heals and keep a close eye on the wound. When you have an infection, you can help to catch sepsis early if it does develop by looking out for the symptoms and seeking immediate medical attention if you have them.