Sepsis still kills one in 5 people worldwide – two ICU doctors propose new way to stop it

<span class=Sepsis begins with a bacterial or viral infection. This panoramic illustration of blood vessels shows rod-shaped bacteria, erythrocytes, and immune cells called leukocytes. Katerina Conn / Science Photo Library via Getty Images“src =” https://s.yimg.com/ny/api/res/1.2/16PUvIuTIa5aODAx9IgATQ–/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTI4NQ–/https://s.yimg.com/uuBap/uu/api/ap/ -~B/aD01ODI7dz0xNDQwO2FwcGlkPXl0YWNoeW9u/https://media.zenfs.com/en/the_conversation_us_articles_815/fa8877fc7732c17810f1254b85fcfacb” data-src=”https://s.yimg.com/ny/api/res/1.2/16PUvIuTIa5aODAx9IgATQ–/YXBwaWQ9aGlnaGxhbmRlcjt3PTcwNTtoPTI4NQ – / https: //s.yimg.com/uu/api/res/1.2/3a0J5pCMfX8QBUU92j3BXQ–~B/aD01ODI7dz0xNDQwO2FwcGlkPXl0YWNoeW9u/https: //media.zenfs.com/en/

Can a healthy young woman die from something similar to the common cold? The answer is, surprisingly, yes, when there are no signs of a more serious problem.

Although many are unaware of this, sepsis — the body’s severe reaction to an infection — is the leading cause of death in hospitalized patients in the United States. Worldwide, sepsis is responsible for 1 in 5 deaths each year. Many of the survivors will never be able to return to work, and some will never be able to return home from the hospital, they will need lifelong support or constant help.

We are two researchers from the University of Pittsburgh School of Medicine and critical care physicians who are working to change the way scientists and physicians think about sepsis. We are interested in understanding and disseminating how sepsis begins and how it can eliminate the most discerning physicians.

We are also learning more about how community factors are playing out and how a better understanding of the communities in which we live can help everyday people and health care providers recognize and stop this deadly disease.

What is sepsis?

Sepsis is a medical emergency that begins with an infection – probably a mild infection. Once it detects bacteria or viruses, your body releases a choreographic cascade of chemicals into the bloodstream. This chemical warning calls for the artillery of immune cells to work together to combat the deficiencies.

When this system works well, your body clears the infection and recovers. However, if the system does not work properly, sepsis can occur.

The onset of sepsis occurs when your immune cells fight infection and fight against your own tissues and organs. This reaction can be similar to an autoimmune reaction, in which the body’s immune system begins to function on its own. Many people are familiar with chronic autoimmune diseases such as rheumatoid arthritis or Crohn’s disease, but sometimes this type of autoimmune reaction can occur in healthy people.

When sepsis occurs, the immune system can be damaged, usually in the heart, lungs, kidneys, or blood cells, among other important body systems. Inflammation of the blood vessels can cause them to leak and dramatically reduce blood flow to the brain and other organs in the blood vessels. In this case, a person’s blood pressure can drop dangerously, a severe form of sepsis called septic shock.

Without prompt and proper treatment – sometimes despite treatment – sepsis can lead to organ damage and even death. When shocks occur, sepsis deaths jump from 10% to 40%.

Sepsis can be caused by almost any infection. It is usually caused by pneumonia or a urinary tract infection. Severe COVID-19 can also lead to sepsis. Patients with sepsis usually seek medical attention for symptoms within a week of being admitted to a sepsis hospital. However, it is very difficult to predict which of the infected patients will develop sepsis.

treatment options

The basis of treatment for sepsis is the immediate recognition of the symptoms of sepsis, followed by antibiotics and fluids. However, even the most careful and attentive doctors may not notice the first signs of sepsis.

This is basically a single test to make a positive diagnosis of sepsis. Symptoms of sepsis can mimic other life-threatening conditions, such as a heart attack, blood clots, bleeding, or an allergic reaction. Patients often present with vague and variable symptoms, such as weakness, dizziness, and rapid breathing, making diagnosis more difficult.

For example, a young person with sepsis due to pneumonia, that is, a healthy person, may be very different from a skin infection and an elderly diabetic with sepsis.

Patients with sepsis almost always require hospitalization or resuscitation, while patients with severe sepsis often require life support. This may include dialysis or mechanical ventilation to support dysfunctional organs. The source of infection must be identified and, in some cases, surgically removed. Delaying treatment for sepsis for several hours can be fatal.

Recognize sepsis before it’s too late

Differences in sepsis go beyond symptoms. COVID-19 revealed that severe pain is not a game of chance. Like COVID-19 infection, sepsis – and who can get sick and die – is part of a complex interplay of social influences that include racism, poverty, geography, and community dynamics.

Studies show that some people have a higher risk of developing sepsis than others. Older people with chronic diseases such as COVID-19, obesity and diabetes are at higher risk of sepsis. Factors such as race, poverty, and even the distance to the hospital can have a significant impact on survivors of sepsis.

Much of the work done to diagnose and improve sepsis has focused on hospital conditions. Doctors, researchers, and even government officials have worked to improve the diagnosis and treatment of sepsis when a patient arrives at the hospital. Research aimed at understanding the risk of sepsis in the individual focuses on personal health history and social and economic factors such as income and race, or community characteristics such as primary care opportunities.

Although these methods have improved the field understanding of sepsis, they have led to some progress in reducing sepsis in the United States.

New ways to catch a killer

Given what is known about the importance of early treatment for sepsis, researchers like us are looking closely at the role of communities in improving the detection of sepsis and understanding the risk of sepsis.

When a patient is at home, the early stages of sepsis can develop rapidly. Researchers estimate that 87% of sepsis cases occur outside the hospital. When a patient seeks care, it is usually in the days before the sepsis is hospitalized, or even a few hours in the clinic or emergency room. These important treatment windows can mean the difference between life and death for a sepsis patient.

Together with researchers based in Kaiser Permanent, Northern California, we are currently working on sepsis care through the study of sepsis patient symptoms, social factors, diagnosis, and outpatient treatment options. We are also expanding our efforts to improve the diagnosis of sepsis among hospitalized patients. This coast-to-coast collaboration examines patients in a critical mass of more than 40 hospitals, 30 EMS agencies and outpatient clinics. We hope that our work will shed light on the early stages of sepsis, including signs that an infected patient is progressing to sepsis, and will explore diagnostic and treatment options that can help stop sepsis from developing further.

We are also learning more about the complex role of collective factors such as poverty in health, including sepsis. Using the “syndemic theory,” which is the basis for describing synergistic epidemics caused by harmful social conditions, we are exploring how two epidemics, such as poverty and asthma, can work together to increase health outcomes. Although this framework has only been used to study acute disease, it has the potential to change the way we think about sepsis.

This article was reprinted from The Conversation, a non-profit news site dedicated to sharing the ideas of academic experts. Written by Emily Brant, Pittsburgh University of Health Sciences and Christina E. Rudd, Pittsburgh University of Health Sciences.

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Emily Brant works at the University of Pittsburgh School of Medicine and the UPMC Health Care System. He received grant funding from the National Heart, Lung and Blood Institute (NHLBI), the National Institutes of Health (NIH) and the Gordon and Betty Moore Foundation. There is no conflict of interest for his statement.

Christina E. Rudd works at the University of Pittsburgh and the UPMC Health Care System. He advises Janssen Pharmaceuticals. It receives grant funding from the National Institute of General Medical Sciences and the National Institute of Heart, Lung and Blood (National Institutes of Health).

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