Sepsis is a medical emergency that can rapidly become life-threatening. It arises when the body’s response to an infection causes widespread inflammation and organ dysfunction. Despite medical advances, it remains a leading cause of death globally. In this guide, we break down everything you need to know—from signs and symptoms to risk factors, pathophysiology, and life-saving treatment protocols.
What Is Sepsis?
Sepsis is the systemic inflammatory response triggered by the presence of pathogenic organisms or their toxins in the blood or tissues. These organisms can be bacteria (bacteraemia), viruses (viraemia), or fungi (fungaemia). The condition ranges from mild infection-related inflammation to septic shock, where multiple organ systems fail due to inadequate blood flow.
Types of Sepsis
- Uncomplicated Sepsis: Early stage without significant organ damage.
- Severe Sepsis: Accompanied by acute organ dysfunction (MODS).
- Septic Shock: Persistent hypotension despite fluid resuscitation.
Organs Affected by Sepsis
Central Nervous System (CNS):
- Agitation
- Drowsiness
- Hypoventilation
Lungs:
- V/Q mismatch
- Pneumonitis
- Acute Respiratory Distress Syndrome (ARDS)
Heart:
- Tachycardia
- Reduced Stroke Volume
- Myocardial Dysfunction
Liver:
- Hyperglycaemia
- Jaundice
- Azotaemia
Kidneys:
- Oliguria
- Tubular dysfunction
- Acute Tubular Necrosis (ATN)
Gastrointestinal Tract:
- Reduced motility
- Bacterial translocation
Peripheral Vascular System:
- Increased peripheral resistance
- Hypoperfusion
- Peripheral lactic acidosis
Key Points for Clinicians and Caregivers
- Sepsis has a 25% mortality rate globally.
- Early management, within the first 6 hours, significantly improves survival.
- Common sources: urinary tract infections, biliary infections, pneumonia, and surgical site infections.
- Prompt culture tests should precede antibiotic use.
- The "Sepsis Six" bundle must be initiated within the first hour.
The “Sepsis Six” Bundle
- Give high-flow oxygen
- Take blood cultures
- Administer IV fluids
- Start IV antibiotics
- Measure serum lactate
- Monitor hourly urine output
Epidemiology of Sepsis
Globally, over 30 million cases are reported annually. It affects all ages, but the elderly and immunocompromised are particularly vulnerable. The mortality rate for septic shock can exceed 40-60%, especially if treatment is delayed.
Risk Factors for Developing Sepsis
- Age: Infants and elderly
- Chronic illnesses: Diabetes, kidney failure, liver disease
- Immunocompromised state: HIV/AIDS, cancer, chemotherapy
- Surgical interventions: Catheterization, biopsies, and drains
- Severe trauma or burns
- Infections: UTI, pneumonia, cellulitis, cholangitis
Pathophysiology of Sepsis
Sepsis initiates a cascade of immune responses:
- Abnormal coagulation → disseminated intravascular coagulation (DIC)
- Increased capillary permeability → hypotension and edema
- Cell apoptosis and endothelial injury → organ dysfunction
- Increased TNF-α and neutrophilic activity → systemic inflammation
- Poor glycaemic control and adrenal suppression
Diagnosis of Sepsis
Clinical Criteria:
- Fever or hypothermia
- Tachycardia
- Tachypnea
- Altered mental status
- Low blood pressure
- Decreased urine output
Investigations:
- Blood cultures
- Lactate levels
- CBC, CRP, Procalcitonin
- Renal and liver function tests
- Imaging (e.g., chest X-ray, ultrasound)
Management and Treatment
1. Initial Resuscitation
- Central Venous Pressure: 8–12 mmHg
- MAP ≥65 mmHg
- Urine output ≥0.5 mL/kg/hr
- Oxygen saturation ≥65%
2. Antibiotic Therapy
- Start within 1 hour of diagnosis
- Empirical broad-spectrum antibiotics
- Modify based on culture results
3. Fluid Resuscitation
- Crystalloids preferred (e.g., 0.9% NaCl)
- 1000 mL bolus over 30 minutes
- Monitor CVP and MAP
4. Vasopressors and Inotropes
- Noradrenaline or dopamine to maintain MAP
- Dobutamine for myocardial dysfunction
5. Steroids
- IV hydrocortisone if fluids and vasopressors fail
6. Blood Products
- Hb target: 7.0–9.0 g/dL
- FFP for coagulopathy
- Platelet transfusion <5000/mm³
Supportive Therapies
| Aspect | Management |
|---|---|
| Mechanical Ventilation | Tidal volume 6ml/kg, elevate head of bed 30° |
| Sedation & Pain | Use neuromuscular blockers cautiously |
| Glucose Control | IV insulin to maintain glucose <8.3 mmol/L |
| Renal Support | Continuous Renal Replacement Therapy |
| Bicarbonate | Not routinely recommended |
| DVT Prophylaxis | Low molecular weight heparin + mechanical methods |
| End-of-Life | Realistic expectations & family communication |
Complications of Sepsis
- Multiple Organ Dysfunction Syndrome (MODS)
- Disseminated Intravascular Coagulation (DIC)
- Acute Respiratory Distress Syndrome (ARDS)
- Long-term cognitive impairment
- Persistent inflammation and immune suppression
Prognosis and Recovery
Prognosis depends on:
- Early recognition and intervention
- Patient’s age and comorbidities
- Source and severity of infection
Mortality rate can reach 40–60% in septic shock cases. Survivors may face prolonged ICU stays and physical/mental rehabilitation.
FAQs on Sepsis
1. What are early warning signs of sepsis?
High fever, confusion, rapid heartbeat, low BP, and decreased urination.
2. Can sepsis be prevented?
Yes. Vaccinations, hygiene, early treatment of infections, and careful post-surgery care help.
3. Is sepsis contagious?
No. The infection may be contagious, but sepsis itself is the body’s response.
4. Who is most at risk of sepsis?
Elderly, newborns, and people with chronic diseases or compromised immunity.
5. How fast does sepsis progress?
It can become critical within hours, so early detection and treatment are vital.
Conclusion
Sepsis is not just an infection—it is the body’s overreaction to it. Rapid diagnosis, the implementation of the “Sepsis Six,” and continuous monitoring can make the difference between life and death. Public awareness, preventative care, and adherence to clinical protocols are key to reducing sepsis-related morbidity and mortality.
