• Sepsis or Septicemia is an ill-defined term referring to the presence of bacteria or their toxins in the blood.
• It is a life-threatening clinical condition with extensive physiological (normal functions of humans) and biochemical abnormalities leading to multiple organ dysfunction and several abnormal lab values.
• Sepsis is also defined as “organ dysfunction caused by a dysregulated response of the patient to infection”.
• Mind you, Sepsis is NOT severe infection!
• It is a serious medical condition characterized by a whole-body inflammatory state (called a Systemic Inflammatory Response Syndrome or SIRS) caused by SOME bacterial infection.
• Sepsis is not caused by viral infection but a sinister viral infection may get secondary bacterial infection that may lead to Sepsis; as was seen during Covid pandemic.
• Approximately 49 million people are affected by sepsis every year and it is estimated that 11 million deaths are caused by the syndrome, accounting for up to 19.7% of all deaths worldwide.
  • Globally, mortality rates seem to be declining on an average, however, up to 25% of patients still succumb to sepsis.
  • Septic shock, a subgroup of sepsis, characterized by profound circulatory, cellular and metabolic abnormalities, the hospital mortality rate approaches 60%.

Tests that suggest severity?

• Biomarkers related to infection severity –
  • Procalcitonin (PCT),
  • Cytokines (IL-6/ TNF-⍺),
  • C-reactive protein (CRP)

Why does Sepsis have high fatality rate?

• Sepsis targets one or more of vital (target) organs of the body
  • Lung à Acute Respiratory Distress Syndrome (ARDS) à needs ventilator
  • Kidney à Acute Renal Failure à needs dialysis
  • Brain à Encephalopathy à altered sensorium à needs prolonged ICU management

• Heart à Cardiovascular shock à inability to sustain blood pressure at normal levels à needs inotropes
  • Liver à acute hepatic failure à hepatic encephalopathy à needs prolonged ICU management

Multiple Organ Dysfunction Syndrome

• When more than one vital organs are involved, sepsis can lead to septic shock, MODS (Multiple Organ Dysfunction Syndrome) and death.

Who is more at risk?

• The very young and
• The very old,
• Diabetics (more if uncontrolled)
• Cancer
• COPD/ CKD/ Cirrhosis
• Patients with an impaired immune system.
• Patient with a compromised vital organ
• CKD + Acute renal failure (due to severe infection, fluid loss etc) à Sepsis
• CLD + acute viral/ alcoholic hepatitis à Sepsis
• Fulminant TB + Pneumonia à Sepsis
• Interstitial Lung Disease + Pneumonia à Sepsis
• COPD + Pneumonia/ exacerbation/ Ac bronchitis à Sepsis
• HIV positive + any opportunistic inf à Sepsis

Treatment involves:

• Higher and multiple antibiotics
• Support the function of the lungs, kidneys, heart.
  • Artificial ventilation (ventilator)
  • Dialysis (Peritoneal dialysis or Hemodialysis)
  • Inotropes (dopamine, norad)

Way out?

• A decisive factor is the time of correct diagnosis and the initiation of causal, supportive, and adjunctive measures.
• This implies that increasing awareness of sepsis, high index of suspicion, early diagnosis and rational referral is need of the hour!
• Only timely fluid resuscitation and early administration of broad-spectrum antibiotics have been shown to reduce mortality.

Insurance abuse

• Severe infection is labelled as sepsis and high-end antibiotics used even for innocuous viral infections and patients kept for prolonged periods.
• Assessing a claim of sepsis, also needs expertise.
• drchasrani@inchesgroup.com