I knew very little about sepsis until a dear friend of mine came down with it.
I knew the word. But I thought it meant some sort of nasty infection, and my knowledge was very vague, involving the archaic term “blood poisoning.” I have a vivid memory of the first time I ever heard that expression. When I was a young child my grandmother, who’d been born in 1884, told me the story of Calvin Coolidge’s son, who had once gotten a blister from playing tennis and then got blood poisoning and quickly died.
Needless to say, this made a deep impression on me. My guess is that my grandmother wanted to make sure I washed any boo-boos and put some mecurochrome on them.
It turns out the Calvin Coolidge Jr. story my grandmother told me was correct, as you can see from this article that tells the tale of what happened. But the author demonstrates a basic misunderstanding of the situation when he writes this, and then goes on to indicate that antibiotics would have been the answer:
Deaths from sepsis unfortunately were quite common in Coolidge’s time. Ordinary wounds, accidents, and childbirth were all ways in which bacteria could get into one’s normally sterile blood. Patients presenting with fever, low blood pressure, and an obvious site or cause of infection could be diagnosed with relative ease, but the treatment options available were minimal, and the mortality rates were high.
Actually, deaths from sepsis unfortunately are quite common in our time, too. Sepsis develops with lightening speed in situations in which the patient often isn’t even aware of the location of the infection. Certainly, even today a blister such as the one Coolidge’s son had is not usually treated with antibiotics, or effective antibiotics; we don’t need to take antibiotics for every small scrape or scratch (most of which will never be infected), and some bacteria are drug-resistant (sepsis can sometimes follow fungal, parasitic, or viral problems, too, but that’s not as common).
But even more importantly, that last sentence of the quote is still true: “Patients presenting with fever, low blood pressure, and an obvious site or cause of infection could be diagnosed with relative ease, but the treatment options available were minimal, and the mortality rates were high.” Patients with those symptoms could and should be diagnosed, but the diagnosis is sometimes missed. But even a prompt “sepsis” diagnosis of a patient with those symptoms might not save that person because by the time a patient has low blood pressure, something called septic shock is probably setting in, and multiple organ failure can occur within hours, even with the most heroic efforts known to modern medicine. Antibiotics and other medications are poured into the patient, and very often a coma is induced and a respirator connected and dialysis is commenced, but it’s often to no avail.
How many people get sepsis these days, and how many people die of it? A lot of them:
A common and devastating condition, sepsis has significant healthcare implications worldwide. An estimated 1 million cases occur in the United States annually, causing more deaths than prostate cancer, breast cancer, and HIV/AIDS combined. The combined economic toll approaches $17 billion.
Devastating and common indeed, and insidious in its onset, and the public is relatively unaware of its existence. It’s difficult to recognize in its early stages, when intervention matters most, and with astoundingly high mortality as it quickly progresses (and I’m talking about a matter of a day or two or even just hours) into something systemic and lethal. And survivors ordinarily have a slow and agonizing recovery with many complications.
Severe sepsis occurs when a patient with documented sepsis goes on to develop acute organ dysfunction with hypoperfusion and tissue hypoxemia. The most commonly affected organs are the kidneys, lungs, heart, and blood vessels. In some cases, neurologic or hepatic dysfunction may be the primary organ dysfunction.
Finally, the patient may develop septic shock (also called distributive shock) from volume loss in the core circulation and poor circulatory support. Typically, septic shock causes a life-threatening blood pressure drop, reduced urine output, and body temperature changes—late signs of inadequate tissue oxygenation. Unless detected and treated early, it can spiral quickly into multisystem failure and death. Severe sepsis is the most common cause of death among patients in noncoronary critical care units.
I don’t want to scare you, but I feel the need to alert you. Sepsis is “increasing in frequency, expensive to treat, and lethal, with an associated rate of death as high as 70%.”
Actually, higher if you have certain signs of multiple organ failure (which my friend has).
The problem is not actually the infection itself. The more destructive problems involve the normal inflammatory reaction to infection, reactions which then careen madly and precipitously out of control:
Normally, when bacteria or other microbes enter the human body, the immune system efficiently destroys the invaders. In sepsis the immune system goes into overdrive, and the chemicals it releases into the blood to combat the infection trigger widespread inflammation that can ravage the entire body…
In a classic systemic infection, such as a strep throat, the body’s immune response is self-limiting: the immune forces are marshaled, the battle is fought, and the army retires. Sepsis begins like a typical infection, and often it presents initially with the signs of a classic systemic infection—fever, tachycardia, tachypnea, and an elevated white blood cell count. However, in sepsis the natural checks and balances have failed. Instead of tapering off and disappearing, the inflammatory forces spread beyond the infected region.
And the body effectively and quite efficiently destroys itself. Time is of the essence. For every hour of delay in treatment, mortality rates increase 8%. Sepsis is more common in the old and debilitated, but by no means limited to them. Young people can get it, healthy people can get it, active people can get it. Recognize those signs: the person feels bad, usually has a fever but not always, has a rapid heartbeat and respiration rate, sometimes trouble breathing, and often reduced urine output. Get to a good hospital immediately. This is an enormous and critical emergency.