WhatsApp
September 13, World Sepsis Day, is an important day of awareness created to remind us of the vital importance of early recognition and rapid treatment of sepsis.
Sepsis is a medical emergency that must be recognized early and treated rapidly. Delay in early diagnosis and appropriate treatment may lead to serious consequences such as septic shock, multiple organ failure, and death.
What Is Sepsis?
Sepsis is a serious clinical condition that develops when the body loses control of its response to infection and may lead to life-threatening organ dysfunction.
Sepsis can be seen in every age group. Approximately 80% of cases develop outside the hospital, in the community. The most common sources of infection include pneumonia, urinary tract infections, intra-abdominal infections, and skin-soft tissue infections.
Who Is at Risk for Sepsis?
Although sepsis can develop in anyone, the risk is higher in some groups:
- Newborns
- Children
- Pregnant and postpartum women
- Older adults
- Patients with suppressed immune systems
- People with chronic diseases
What Are the Symptoms of Sepsis?
In a patient with suspected or known infection, the possibility of sepsis should be evaluated rapidly if the following findings occur:
- Fever or a significant drop in body temperature, hypothermia
- Rapid breathing or respiratory distress
- Increased heart rate
- Altered consciousness
- Marked decrease in urine output or inability to urinate
- Low blood pressure
- Impaired skin circulation
- Rapid deterioration in general condition
How Is Sepsis Evaluated?
In the evaluation of sepsis, the patient’s clinical findings, vital signs, laboratory results, and organ functions are assessed together. Healthcare professionals may use evaluation systems such as SIRS, qSOFA, and SOFA.
These scores are not used alone for patients to diagnose sepsis on their own. Clinical evaluation should always be performed by healthcare professionals.
What Is SIRS?
SIRS, Systemic Inflammatory Response Syndrome, is defined by the presence of at least two of the following four criteria:
- Body temperature >38 °C or <36 °C
- Heart rate >90/minute
- Respiratory rate >20/minute or PaCO₂ <32 mmHg
- Leukocyte count >12,000/mm³ or <4,000/mm³, or more than 10% band cells in the peripheral smear
With the Sepsis-3 definitions, SIRS criteria have been removed as diagnostic criteria for sepsis. The main reason for this is their low specificity and the fact that they may become positive in many non-infectious conditions as well. However, they may still be used as a practical warning framework that shows the presence of a systemic response in patients with suspected infection.
What Is qSOFA?
qSOFA, quick SOFA, consists of three criteria that can be evaluated at the bedside without the need for laboratory testing:
- Respiratory rate ≥22/minute
- Altered consciousness, Glasgow Coma Scale <15
- Systolic blood pressure ≤100 mmHg
The presence of two or more positive criteria is a warning sign for poor prognosis and prolonged intensive care need in a patient with suspected infection.
qSOFA is not a diagnostic tool and is not recommended to be used alone for screening. It is recommended to be evaluated together with early warning scores such as NEWS or MEWS. A negative qSOFA result does not completely rule out the possibility of sepsis.
What Is the SOFA Score?
SOFA, Sequential Organ Failure Assessment, is a scoring system that evaluates the function of six organ systems.
- Respiration, PaO₂/FiO₂
- Coagulation, platelet count
- Liver, serum bilirubin
- Cardiovascular system, mean arterial pressure and vasopressor requirement
- Central nervous system, Glasgow Coma Scale
- Kidney, serum creatinine or urine output
According to the Sepsis-3 definition, sepsis is defined as an acute increase of 2 points or more in the SOFA score compared with baseline in a patient with suspected infection. In patients without known pre-existing organ dysfunction, the baseline SOFA score is accepted as zero.
What Is Septic Shock?
Septic shock is a more severe form of sepsis. It is defined by the presence of vasopressor requirement to maintain mean arterial pressure at 65 mmHg or above despite adequate fluid therapy, accompanied by a serum lactate level above 2 mmol/L.
How Is Sepsis Treated?
The main approach in sepsis management is to recognize the disease rapidly and start treatment without delay.
Early diagnosis → Rapid evaluation and resuscitation → Appropriate antimicrobial treatment → Control of the source of infection → Organ support therapies
Since delay in treatment may negatively affect the patient’s prognosis, it is critically important for healthcare professionals to consider sepsis early and start the appropriate management steps without delay.
The Process After Sepsis
Sepsis is not limited only to the acute phase of the illness. After sepsis, some patients may experience physical, cognitive, and psychological effects.
Therefore, sepsis management should not be limited only to acute treatment in the hospital; patients’ needs after discharge should also be taken into account.
Preventing infections, reducing healthcare-associated infections, appropriate antibiotic use, and increasing healthcare professionals’ awareness of sepsis are among the key elements in reducing sepsis-related illness and deaths.
Frequently Asked Questions
Is sepsis contagious? +
Can sepsis occur at any age? +
Why is early diagnosis important in sepsis? +
References
- Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock
- World Health Organization (WHO) - Sepsis
- Global Sepsis Alliance - World Sepsis Day
- The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
