The 13th of September 2021 is World Sepsis Day. Accounting for 11 million deaths in the world annually, sepsis is the number one cause of death in hospitals and can affect anyone, with even higher risk among very young, ill, or old people.
The aim of World Sepsis Day is to raise awareness of this often poorly understood illness and highlight the need for a rapid response to reduce the worldwide burden of sepsis. Therefore, understanding the progression of sepsis and knowing what signs and symptoms to look out for, with subsequent early diagnosis and timely treatment, could save a life.
The stages of sepsis
Stage 1: The infection
Sepsis is always the result of an infection be it from a wound or an illness; this is usually a bacterial infection but can also be viral, such as COVID-19. It may be a diagnosed infection where a doctor has prescribed antibiotics, or a mild one which has been treated at home with over-the-counter medication. It’s important to remember that the initial infection does not need to be severe, so any suspected symptoms should be considered.
Stage 2: Onset of sepsis symptoms
The body mounts an immune response to the infection to fight it off. Unfortunately, for reasons not yet fully understood, the immune response starts to attack not only the infection, but also the host’s own body. Sepsis symptoms often have a sudden onset, are wide ranging, and can appear in any order. The organisation behind WSD 2021, the Global Sepsis Alliance, has a helpful mnemonic to remember the symptoms to look out for:
Slurred speech or confusion
Extreme shivering or muscle pain, fever
Passing no urine all day
It feels like you’re going to die
Skin mottled or discoloured
Sepsis is a medical emergency which can progress very rapidly. So, expert medical advice should be sought for any suspected symptom of sepsis, as early diagnosis and prompt treatment is crucial.
Stage 3: Symptoms deteriorate rapidly
If left untreated, sepsis can worsen within only a few hours. As the immune system continues to attack the body, it begins to damage vital organs. This can happen in any order, but the lungs and kidneys are commonly affected first, resulting in difficulties in breathing and passing urine. Some of this organ damage can be permanent, leading to lifelong after-effects in recovered patients.
Stage 4: Sepsis develops into septic shock
As toxins from the infection build up, they can damage small blood vessels. This causes fluid to leak into tissues resulting in a massive drop in blood pressure. Without sufficient pressure, the heart cannot pump enough blood to essential organs. At this point, the risk of mortality is at its highest and intensive care is usually needed for interventions such as ventilation.
Time is crucial
Sepsis is a global health crisis affecting up to 50 million people worldwide a year and causing one death every 2.8 seconds. However, there is hope: survival rates are greatly improved by early diagnosis and treatment. While mortality rates are over 40% for patients admitted to hospital with septic shock, for patients identified sooner with early sepsis, mortality rates decrease to 17%.
Patients with early stages of sepsis, before vital organs are affected, can usually be treated with antibiotics at home and make a full recovery. Once sepsis has progressed to later stages additional treatments such as vasopressors for increased blood flow are used to try to limit the damage of the immune system’s attack on the body. This is why it is vital that awareness of sepsis and its symptoms is raised: the more people who can recognise the early warning signs and seek early treatment, the more people will survive.
Combination of tests needed
Due to the speed at which sepsis can progress, once a patient is suspected as having sepsis clinicians know that they need to act fast. There is no single test for sepsis and so a combination of tests are required to diagnose and ensure its effective treatment. These tests identify if patients have a bacterial or viral infection and how severe the sepsis has become.
Lengthy waits on lab results (especially during peak lab hours and out-of-hours periods) could mean that there is a delay in initiating the most appropriate treatment course. This might adversely impact patient outcomes particularly where intravenous antibiotics need to be promptly instituted, as well as potentially increasing the overall length of the patient’s hospital stay.
Speeding up the diagnostic process can ultimately save patients from permanent organ damage and even death.
Supporting quick decisions
HORIBA Medical designs and manufactures IVD solutions that can enable fast diagnosis and support quick clinical decision making. In the case of sepsis its Microsemi CRP - a compact and user friendly, near-patient haematology analyser - offers an ideal solution.
An invaluable tool for earlier sepsis diagnosis and treatment planning, it uniquely offers simultaneous measurement of full blood count (FBC), including a 3-part differential, and C-reactive protein (CRP) within just four minutes of analysis. The combination of CRP, an inflammatory marker, and a white blood count (WBC) plus granulocyte count, helps to: identify sepsis; distinguish between bacterial and viral infection; and establish disease severity.
Point-of-care CRP with FBC
The Microsemi CRP haematology analyser requires just 10μL of whole blood for FBC, and 18µL for FBC+CRP analysis. This delivers rapid and minimally invasive testing for all patients and is especially helpful for the diagnosis of paediatrics – a risk group for sepsis - who are often difficult to collect large blood samples from.
Due to the unique combination of parameters offered by the Microsemi CRP at the point-of-care, it can support early detection of sepsis, speed up treatment decisions, and inform more judicious antibiotic prescribing. This ultimately improves both patient experience and outcomes.
Read more about point-of-care CRP with FBC testing here.
- World Sepsis Day. Sepsis Fact. Available from: https://static1.squarespace.com/static/597f001fb3db2bde61e79d4a/t/5faac2243d168f22723fe79c/1605026348018/Sepsis_Fact_Sheet_WSD_English.pdf.
- World Sepsis Day. What is Sepsis. 2020; Available from: https://www.worldsepsisday.org/sepsis.
- Sepsis Alliance. What is Sepsis. 2021; Available from: https://www.sepsis.org/sepsis-basics/what-is-sepsis/.
- NHS Inform. Sepsis. 2020; Available from: https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/sepsis.
- NHS Inform. Septic shock. 2020; Available from: https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/septic-shock.
- Mervyn Singer, et al., The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA, 2016. 315(8): p. 801-810.
- A. Padkin, et al., Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med, 2003. 31(9): p. 2332-8.