What Makes Sepsis One Of The Top Causes Of Mortality Across The World?

While fever, fast heart rate, breathing issues, and confusion are among the signs of sepsis, patients are often not able to recognise them, as they can masquerade as other health problems, says a doctor.

Septicemia, also known as sepsis or blood poisoning, is a serious health complication, wherein the host immune system gives a 'dysregulated response' to an infection, usually a bacterium. Dr Vaishali Solao, head of critical care at Fortis Hospital, Mulund explains that the human immune system is 'designed to recognise a foreign organism' -- like bacteria, virus or fungus -- and initiate a cascade of responses to eliminate them from the body. Sometimes, however, the immune system goes overboard and causes harm to multiple healthy organs within the body, besides the organ that is the 'source of the infection'. "Once crucial organs like the kidneys, lungs, brain and liver get affected, mortality due to septicemia increases rapidly," the doctor warns.

Common Signs Of Septicemia

According to Dr Solao, the common signs include:

• Fever
• Fast heart rate
• Difficulty in breathing
• Confusion
• Decreased urine output.

"Patients themselves are not usually able to recognise the signs of sepsis, as they can masquerade [as other health problems], especially in the elderly population, which is most vulnerable. Hospitals, therefore, have protocols and scoring systems in place to recognise sepsis early and initiate treatment," the doctor states, adding that modified early warning score (MEWS) or the qSOFA (quick SOFA) are 'rapid scores' that are used for doctors to be alerted to the possibility of sepsis.

Treatment Of Sepsis

The treatment can be long, the doctor states. It usually looks like this:

1. First, the right antimicrobial has to be given in a timely manner.
2. Guidelines state that all sepsis patients receive an appropriate antibiotic within 1-3 hours, depending on the severity.
3. The biggest step to reducing death due to septicemia is early recognition and treatment. An hourly delay in administering an antibiotic can lead to an increase in the chances of mortality.
4. The second approach is supporting all organs that are affected.
5. Blood pressure may need to be regulated with vasopressors to maintain blood supply to all major organs.
6. Kidney failure may need dialysis, and in case of respiratory failure, the patient may need to be ventilated.
7. The third approach is purifying the blood, although it has not been proven to be very effective. It is attempted in 'extremely sick' patients who have >40 per cent chances of death.

"Extensive research is ongoing to target immune system abnormality, which is the true cause of sepsis. Currently, we do not have any agent that has been successful in regulating the immune system to the extent of reducing mortality due to sepsis," the doctor says.

In Conclusion

The doctor says that sepsis remains one of the top-most causes of mortality across the world, exceeding even cancer and heart attacks. It affects almost 50 million people globally; 15-30 per cent of these patients die.

"Few preventive measures like maintaining good hygiene, drinking clean water, and getting vaccinated can decrease the burden of sepsis. Additionally, early recognition and prompt treatment in a multidisciplinary approach is the most effective way of reducing death due to sepsis."