Boxing great Muhammad Ali, who passed away in June 2016, was well known for his fight against Parkinson’s disease — but he actually succumbed to septic shock. Sepsis — and its most serious form, septic shock — is a body-wide and potentially deadly response to an infection. Sepsis occurs when the immune system releases infection-fighting chemicals into the bloodstream that cause an inflammatory response throughout the body, which can lead to organ failure and death.
More Sepsis or Better Diagnosis?
A 2016 study, published in CHEST, the journal of the American College of Chest Physicians, examined hospital records and claims data at 27 hospitals between 2005 and 2014. The study concluded that diagnoses of septic shock rose by about five percent per year, but deaths from septic shock actually decreased 54.9 percent to 50.7 percent.
Part of the reason for the increase of incidence is better diagnosis, says Sarah LaRosa, DO, assistant medical director for the emergency department of Westside Regional Medical Center in Davie, Florida. “Most hospitals have policies in the emergency room where patients are screened when they come in the door and a doctor is alerted if they meet certain criteria,” she says. “We’re making the diagnosis more often.”
Better diagnosis, says Dr. LaRosa, leads to better treatment. “We’re better able to keep patients alive. Patients used to die before the diagnosis was made,” she says.
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Changes in Definitions
Sepsis and septic shock were redefined in early 2016, with the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Prior to Sepsis-3, there were three conditions ranging from bad to worse: sepsis, severe sepsis, and septic shock. Severe sepsis is sepsis accompanied by organ dysfunction, low blood pressure or low blood flow, and septic shock is severe sepsis that doesn’t improve despite treatment, according to LaRosa.
Sepsis-3 phased out the term “severe sepsis” and now classifies it as part of sepsis. “Septicemia” — another term for sepsis — has also been phased out, LaRosa says. Sepsis-3 changed some of the diagnostic criteria for sepsis and septic shock, as well. Not all doctors or doctors’ organizations use the new definitions or diagnosis, however, so you may still encounter the terms “severe sepsis” and “septicemia.”
Sepsis Symptoms and Diagnosis
At the hospital, medical professionals measure vital signs to look for fever, rapid heartbeat, and rapid breathing. They also look for high levels of lactate — which indicates cell death, says LaRosa — and a high white blood cell count, which is a sign of infection.
Signs to look for include confusion, especially if the person is older. “If they’re not acting like themselves after a fever or a cold, that’s concerning,” says LaRosa. A rapid heart rate and fast breathing are also signs of possible sepsis, she adds. “If someone thinks they have an average cold or flu and the body’s fighting it, that’s great,” LaRosa says. “But if they’re going in the opposite direction [getting worse instead of better], they should get checked out and get treated right away.”
LaRosa says that conditions that commonly develop into sepsis include pneumonia, urinary tract infections, kidney infections, and intestinal infections like colitis or diverticulitis, but “Any infection can lead to septic shock,” she says. The very young, the very old and people with compromised immune systems are at greater risk of sepsis.
The progression of sepsis can happen very quickly, says LaRosa. “We often see patients we categorized as septic who had a cough or a cold for a few days, but sometimes it can be just a day or even a matter of hours,” she says. That means treatment has to be fast, too. Every hour that treatment is delayed increases the chance that sepsis can kill you, according to LaRosa.
Treatment starts with antibiotics, IV fluids, and, frequently, medication to keep blood pressure up. People may also need oxygen or dialysis, as well. Sepsis and septic shock are both emergencies. Call 911 immediately if you’ve recently had an infection and notice any symptoms of sepsis.