Recognizing the signs of sepsis

Sepsis is a serious reaction to an infection that is a medical emergency. More than 1.7 million adults are diagnosed with sepsis each year in the United States, according to the Centers for Disease Control and Prevention (CDC). Of those diagnosed, more than 350,000 will die from sepsis.

While healthcare providers (HCPs) are continually making progress to recognize the signs of sepsis early on, the CDC has made a push to get more information about sepsis into the hands of HCPs and patients.

“It comes down to training,” says Claudio Fernandez, DO, an emergency medicine doctor with Memorial Hospital Miramar in Florida. “I’m an ER doctor so I see sepsis a lot.”

HCPs in emergency rooms tend to have a lot of experience with sepsis, but it’s important for all HCPs to be able to identify its key signs and symptoms. Early recognition and treatment of sepsis can save lives.

What is sepsis?

When the body encounters a foreign substance like a bacteria or virus, the immune system typically responds by identifying and attacking the substance. Inflammation is part of the body’s natural reaction to fend off such threats.

Sometimes, however, the immune system’s response to infection is so aggressive and extreme that it can run out of control and affect otherwise healthy tissue. This is sepsis.

Infants, very old adults, and people with weakened immune systems are the most vulnerable to sepsis, but anyone can get it. Other at-risk populations include those with diabetes, HIV/AIDS, cancer, or liver disease.

What are the symptoms of sepsis?

Sepsis onset occurs rapidly and is unpredictable. Common symptoms include:

• Fever, chills, or shivering
• Rapid breathing and heart rate
• Shortness of breath
• Rash
• Confusion and disorientation
• Extreme pain or discomfort
• Sweating or clammy skin

If your blood pressure decreases and the heart becomes weak, septic shock may occur, which can result in the failure of multiple organs, including the lungs, kidneys, and liver.

Diagnosing sepsis

Diagnosing sepsis is complicated, since symptoms may not be apparent until late, when the person is already very ill. Some symptoms of sepsis can also resemble those of other conditions. HCPs use a combination of a patient’s medical history, blood work, and physical signs to determine whether sepsis is present, Dr. Fernandez says.

Medical history is important because it can help reveal how the infection started. Some of the most common types of infection that can lead to sepsis include:

• Respiratory infections, such as pneumonia
• Urinary tract infections
• Gastrointestinal infections, including infection of the appendix (appendicitis) and infection of the abdominal cavity (peritonitis)
• Skin infections

If an HCP thinks someone has sepsis, they will calculate a score to help determine how severe that person’s sepsis is and how aggressively they need to be treated. The scoring system is called qSOFA, which stands for quick sepsis-related organ failure assessment.

“I’m looking for the vitals,” says Fernandez. “Is the patient feverish? How’s the breathing, is it fast?”

Other qSOFA criteria include low blood pressure or altered mental state, which could include confusion, lethargy, disorientation, strange behavior, or even hallucinations. A score of two or more, along with a suspected infection source like pneumonia, suggests that a case of sepsis is more severe, with a higher risk of death and other complications.

A 2022 systematic review published in BMJ Open found that including a measure of blood lactate levels in the qSOFA score helped predict the risk of death in people with sepsis.

Treating sepsis

Intravenous (IV) fluids and antibiotics are the main treatments for sepsis. Treatments like dialysis and breathing machines may be necessary to keep failing organs working, as may medications to increase blood pressure. In severe cases, surgery may be required to remove tissue that has been damaged as a result of sepsis.

Since sepsis develops quickly and in stages, it’s extremely important to recognize the signs and get treated as soon as possible.

“The earlier you recognize sepsis, the earlier you can start treating it,” says Fernandez.

The 2021 Society of Critical Care Medicine guidelines recommend that antibiotics be administered ideally within 1 hour of sepsis diagnosis or within 3 hours if sepsis is suspected. While this is the ideal, HCPs may have leeway in the timing of antibiotics administration.

Sepsis that remains untreated can progress to septic shock, a life-threatening condition. In 30 to 40 percent of cases, septic shock can be fatal.

Recovering from sepsis

After being treated for sepsis, the priorities for recovery should be resting and getting help with daily needs, such as standing, walking, bathing, and other self-care. You may experience any of the following during recovery:

• Fatigue
• Weakness
• General aches and pains
• Shortness of breath
• Difficulty sleeping
• Loss of appetite

Many people who experience sepsis recover fully. Certain patients, such as those with pre-existing conditions, may have a more difficult recovery. Some patients may need continued dialysis, and in other cases, memory and thinking problems and a weakened immune system may continue following sepsis.