What is being septic: What is sepsis? | Sepsis
Symptoms, Diagnosis & Treatment > Fact Sheets > Yale Medicine
As with adults, when babies and children develop an infection, their immune systems fight the invading culprit, whether it’s bacteria, a virus, or a fungus. But sometimes the immune system’s response to an infection can spin out of control, leading to a life-threatening condition called sepsis. Sepsis occurs when the body’s response to an already-present infection gets out of hand, leading to severe inflammation throughout the body that, in turn, can cause tissue damage and organ failure. When organs begin to stop functioning, the body can enter a stage of sepsis called “septic shock,” and the threat of death is imminent.
While sepsis is a serious condition at any age, it is particularly dangerous for children because their symptoms can be more difficult to detect. “The biggest difference between adult and pediatric sepsis is recognition,” says Yale Medicine pediatric intensive care doctor Sarah Kandil, MD. “A lot of symptoms we look for in sepsis, like a fever, are similar to other illnesses in children.”
Though pediatric sepsis is unusual, it’s not all that rare either. Studies estimate that more than 75,000 children are treated for severe sepsis each year in the U.S.
Sepsis can develop from an injury as simple as an infected scrape on the arm, or it can emerge on top of an already life-threatening condition, such as acute appendicitis. “Those who have a weakened immune system, like kids undergoing chemotherapy, can be especially susceptible,” Dr. Kandil says.
Besides being more difficult to detect in children, parents, caregivers, and even medical staff may not have enough knowledge about the signs of sepsis. “We have an ongoing campaign in at Yale New Haven Children’s Hospital that encourages medical providers and families to be aware of sepsis,” Dr. Kandil says.
All Yale Medicine’s pediatric care providers are trained to recognize the early signs of sepsis in children, in order to provide quick and accurate care to interrupt the condition’s progress.
Septic Shock: Causes, Treatment, Complications
Although septic shock is a complication of sepsis, septic shock has its own set of possible complications. This is because a dangerously low blood pressure affects oxygen levels and blood flow.
While severe sepsis can limit organ function, septic shock leads to complete organ failure when inflammation and low blood pressure aren’t controlled. Between severe inflammation triggering blood clots and low blood pressure causing inadequate blood flow, your organs may not receive sufficient oxygen or blood to function properly. (2)
Kidney failure, heart dysfunction, respiratory failure, and multiple organ failure are all complications of sepsis and septic shock, notes Brown. “Patients may need dialysis temporarily or long-term if their kidneys are shutting down, and death can occur if multiple organ systems become dysfunctional and shut down.”
She further relates the dangerous effect of low blood pressure on the brain, stating the increased likelihood of stroke when blood can’t circulate to all areas of the brain.
In addition to possible organ failure, septic shock can lead to amputation of a limb. The risk for amputation increases when blood clots form in the body. Blood clots prevent the passage of blood. And when parts of the body are deprived of blood and oxygen long term, body tissue starts to die. (2)
Sometimes, the damage is reparable. When too much of your body tissue dies, the only option is to remove the dead tissue. This may involve removal of a finger, toe, foot, arm, or leg. (4)
Even if you recover from septic shock, you may live with post-sepsis symptoms for weeks or months. (9)
“Recently, we are starting to recognize how sepsis can cause patients to be debilitated for long periods of time, and very weak after they leave the hospital,” explains Brown. “The combination of being hospitalized, fighting off an infection, and being immobile can cause significant wear and tear on the body.”
Post-sepsis symptoms can include insomnia, fatigue, depression, and cognitive decline. (9)
One Last Thing on Preventing Sepsis and Avoiding Septic Shock
If you suspect sepsis, it’s important that you go to the hospital immediately. The longer you wait, the greater the risk of the infection progressing into a life-threatening emergency.
Unfortunately many people diagnosed with septic shock don’t survive. And because this condition strains the immune system, there’s also the risk of recurrent infections after leaving the hospital. (2) Therefore, learning how to recognize symptoms and thus get early treatment is your best chance of survival.
What Happens When Your Body Is in Septic Shock?
What do Muppet creator Jim Henson, singer Chuck Brown, and boxer Muhammad Ali have in common? They all died of the same thing: septic shock, triggered by an infection. Sadly, conditions like septic shock can bring the most diverse of people together. Before penicillin was discovered in the early 1900s, dying from an infection and septic shock was common place, no matter who you were. And while penicillin and other antibiotics have saved millions of lives over the years, infections still cause deaths around the world, including over 258,000 people in the United States every year.
Most people know of someone or have heard of someone who died of a common infection, such as pneumonia, influenza or a urinary tract infection. In reality, it’s not the infection that caused the death. It was septic shock, triggered by the infection. Septic shock is a medical emergency. It is a dangerous and life-threatening condition that occurs when your blood pressure drops and stays too low after you have developed an infection.
How does septic shock develop?
When you get an infection, your immune system tries to protect you by producing extra white blood cells that are programmed to seek out and destroy invading organisms. When all goes well, your immune system fights off the infection, although you may need help from some medications such as antibiotics or antivirals. If the organism enters the bloodstream it can quickly multiply and spread throughout the body. As this happens the germ releases toxic substances that poison the blood vessels and aggravate the immune system. Sometimes your immune system may go awry, and instead of fighting the infection, it turns on itself, attacking the healthy cells. When this happens, you develop sepsis. It is your body’s toxic response to the infection.
The first signs of sepsis may be quite vague, but they include low blood pressure, fast heartbeat, or a higher or lower than usual body temperature. Blood tests may show a higher than normal number of white blood cells in your blood. If the infection isn’t treated or controlled at this point, sepsis can progress to severe sepsis. One or more organs, like your kidneys or lungs, start to fail, and tiny blood clots may form in your blood, restricting blood flow to your limbs.
Severe sepsis, if not treated quickly, can lead to septic shock.
How is septic shock treated?
People who are in septic shock need urgent intensive care. The medical team has to approach treatment from different angles for it to be successful:
Raise your blood pressure: IV fluids usually help raise blood pressure, but you may need medications called vasopressors. These narrow the blood vessels, which then in turn increases your blood pressure and sends blood to your vital organs.
Treat the infection: Your doctors must find out what caused the infection that triggered the sepsis and give the appropriate antibiotics.
Provide oxygen: You may have an oxygen mask over your nose and mouth, or a tube just under your nose, to deliver oxygen for you to breathe. If your lungs are failing, you may be intubated, which means a tube will be inserted through your mouth into your trachea, which leads to your lungs. This tube will be attached to a ventilator, which will help you breathe.
Surgery: Surgery may be done for two reasons, to clear out infection or to remove dead tissue. Some people with septic shock develop gangrene in their hands, arms, feet, legs, or even their nose and ears. The tiny blood clots that formed in the blood vessels can prevent blood flow to the limbs. Also when the body is in shock, it tries to concentrate the blood flow to the most important parts, such as the brain. If other parts of the body, such as fingers and toes, don’t get good enough blood flow, the tissue can die, causing gangrene. Amputation is the only option once gangrene is present.
Septic shock can almost always be prevented. If you have an infection, it’s important to watch for signs of sepsis. If you suspect that you may have sepsis, go to your local emergency room or urgent care clinic right away. Early treatment can and does save lives.
Recovering from Sepsis
Sepsis is an extreme immune reaction of the human body toward serious bacterial infection circulating in the bloodstream. It becomes life-threatening or lethal when it manifests in the extreme stages of severe sepsis and septic shock.
The time it takes for full recovery from sepsis for each individual differs. Recovery depends on several factors such as the severity of infection, the patient’s overall health condition, and the type of treatment provided.
Effects of sepsis. Presence of numerous bacteria in the blood, causes the body to respond in organ dysfunction. Image Credit: Designua / Shutterstock
Mild Sepsis Recovery
In mild sepsis, complete recovery is possible at a quicker rate. On average, the recovery period from this condition takes about three to ten days, depending on the appropriate treatment response, including medication.
Severe Sepsis Recovery
Severe sepsis requires immediate treatment in the critical care area for a period of one month or more. Recovery is achievable, but it takes a longer time. Many individuals are known to have regained normal health after severe sepsis without residual dysfunctions. In severe sepsis, the recovery period duration varies from patient to patient, as it depends on the number of organs impacted by the infection and the extent of organ dysfunction.
Post-Sepsis Syndrome (PSS)
About 50% of severe sepsis survivors experience either short- or long-term cognitive and physical problems, collectively termed as post-sepsis syndrome, during their recovery period. The difficulties may include physical (excessive fatigue, weaker muscle strength, bloated limbs, and chest pain), psychological (anxiety, memory loss), and mental (inability to do simple arithmetical calculations) issues.
Recovery from Post-Sepsis Syndrome:
It is necessary to provide rehabilitation facilities to the patient so that they can return to normal life. The duration of recovery from PSS is about two years or more.
Recovery at hospital: Recovery from post-sepsis syndrome is initiated in the hospital by the physiotherapist, who helps the patients to carry out simple everyday activities on their own, such as:
- bathing, getting dressed, and walking
- doing physical exercises, as advised by the physiotherapist, in order to regain muscle strength
Recovery at home: After discharge from hospital, the sepsis survivor needs detailed care at home along with regular reviews with the healthcare provider.
- They need to have complete rest and build up their strength with slowly increasing activities, as they are likely to feel weak and tired.
- A balanced diet is essential. Small meals and supplemental nutrition drinks are suggested for those with a lack of appetite.
- To avoid depression and anxiety, interaction with family and friends is necessary.
- Small targets are fixed to achieve daily tasks.
Recovery After a Hospitalization for SepsisPlay
Septic Shock Recovery
Septic shock is a life-threatening stage of generalized infection, where the chance of patient survival is only about 50%, owing to multiple organ dysfunction associated with low blood pressure. Complete recovery from septic shock would imply the termination of any auxiliary therapies, which is not usually possible. In most cases, a patient with pre-existing chronic disease who survives septic shock is likely to need lifelong supportive treatment because of permanent organ dysfunction.
Rehabilitation for Patients with Amputated Limbs
Amputation of a part of the body, such as one or more fingers or toes, or of a limb, either in part or completely, is sometimes done to increase the rate of survival in patients who develop gangrene during septic shock. Amputation leads to scarring and changes in the structure of normal tissue, which is termed contractures, as a result of the normal wound healing process. To prevent contracture, the physiotherapist will recommend
- exercises to make the joint muscles mobile
- scar massage once it is healed;
- application of appropriate splints to hold the scar area in a stretched position
- appropriate medication to avoid pain
- in case of amputation of lower limbs, the use of prosthetic (artificial) limbs is helpful for the independent movement of young patients, while crutches or wheelchairs may be useful for elders
Rehabilitation of Patients with Kidney Damage
Even after surviving septic shock, some patients require lifelong dialysis due to kidney failure.
- The patient should perform physical activities like walking and moderate exercises
- Perform small tasks with a goal-oriented approach to achieve eventual independence to as large an extent as possible
- Go for dialysis therapy as scheduled by the doctor
- Since dialysis is not a cure, the patients may be registered for renal transplantation to ensure partial or complete recovery
New Findings in Recovery of Sepsis
Patients with late stages of sepsis need more time to recover when there is post-sepsis or sepsis-induced organ dysfunction. More research or studies are needed to find the best way of overcoming these complications.
Neutralization of HMGB1 Protein
A recent report by the Journal of Leukocyte Biology states that if a protein called high mobility group box 1(HMGB1), which is elevated in the late stages of sepsis, is increased or neutralized, white blood cell (neutrophil) dysfunction can be corrected. This promotes the ability of the body to destroy bacteria during the recovery period.
Mesenchymal Stem Cell Therapy
The world’s first trial of stem cell therapy for sepsis was performed in Ottawa. A septic shock patient in Ottawa hospital was administered 30 million mesenchymal cells along with the specific treatment for sepsis, which resulted in complete recovery.
The Relationship Between Sepsis and COVID-19: What We Know
By the bioMérieux Connection Editors
The Global Sepsis Alliance has stated that COVID-19 can cause sepsis, the body’s overwhelming and life-threatening response to an infection that can lead to organ damage and death. In the U.S., one in three patients who die in a hospital die of sepsis. Many different types of infections can cause sepsis, but the most common cause is pneumonia. Pneumonia is severe lung inflammation that occurs in response to an infection in which the air sacs fill with pus, making it difficult to breathe. Bacterial, viral and fungal infections can cause pneumonia and therefore sepsis.
Research suggests that COVID-19 may lead to sepsis due to several variables, including direct viral invasion, the presence of a bacterial or viral co-infection, and/or the age of the patient.
Two published case series about patients with severe COVID-19 from the Seattle, WA, area reported septic shock severe enough to require drugs to support the heart and circulation in almost 70% of patients. The overall organ damage among these patients was also substantial. More than 30% of patients in one series had evidence of liver injury and 75% had evidence of a depressed immune response. The other series reported acute kidney failure in almost 20% of affected patients requiring ICU care. In these studies, the great majority of patients tested negative for co-infection of bacteria and viruses. The lack of bacterial or viral co-infection suggests that the observed septic shock and/or organ damage may have been directly related to SARS-CoV-2.
While viral sepsis is a possible complication of SARS-CoV-2, viral infections alone generally do not cause sepsis as frequently as bacterial infections do. For example, seasonal influenza is commonly associated with bacterial co-infection that leads to severe illness. It is typically this kind of severe illness that requires admission to the ICU and causes ventilator-associated pneumonia. Often times, flu-associated bacterial co-infection is caused by pathogens that colonize in the nasopharynx—the upper part of the throat that sits behind the nose. Common bacterial pathogens that lead to pneumonia and sepsis include staphylococcus and streptococcus. From the case series previously discussed, COVID-19 may differ from seasonal influenza, causing sepsis more often by itself, rather than from a bacterial co-infection.
However, other data suggest that co-infection with COVID-19 may be more common. A study published in April 2020 investigated the co-infection rates between SARS-CoV-2 and other respiratory pathogens and found that more than 20% of positive SARS-CoV-2 specimens also tested positive for one or more non-SARS-CoV-2 pathogens. These specimens came from symptomatic patients, with symptoms ranging in severity. A retrospective study of hospitalized COVID-19 patients found an even greater likelihood of co-infection. The study showed that, of patients who did not survive, half had experienced a secondary infection. Of the non-survivors, 100% of patients had sepsis and 70% were noted to have septic shock.
In the case of COVID-19, the virus’s effect on the body as a whole and its relationship to sepsis are not yet well understood. This may be due to inconsistent testing for secondary pathogens and because researchers are still trying to determine what the best care and treatments are for COVID-19. While certain treatments seem promising, such as convalescent plasma, dexamethasone, or the antiviral treatment, remdesivir, they are still experimental. The current health of the patient, age, and presence of co-morbidities can also play a role in patient outcomes. Overall, COVID-19 can have a vast impact on virtually all organ systems, and the severity of its impact on the organs is directly associated with survival. Even though researchers are still investigating the relationship between COVID-19 and sepsis, proper care for sepsis in patients with severe COVID-19 remains very important.
Opinions in this article are not necessarily those of bioMérieux, Inc.
Research gives clear target for drug development and further study into memory loss — ScienceDaily
The loss of memory and cognitive function known to afflict survivors of septic shock is the result of a sugar that is released into the blood stream and enters the brain during the life-threatening condition. This finding, published today in the Proceedings of the National Academy of Sciences, explains the premature mental aging that follows septic shock and may shed light on memory loss in other diseases.
“This sugar is getting into the hippocampus, and it shouldn’t be in there,” said Robert Linhardt, professor of biocatalysis and metabolic engineering at Rensselaer Polytechnic Institute, and lead author of the study. “We actually think this is rewiring memory in the hippocampus, and it’s causing memory loss. Neural circuits are being disrupted or broken or connected in the wrong way.”
The study is the latest outcome of a six-year partnership between Linhardt and Dr. Eric Schmidt, an expert on sepsis and assistant professor in the Department of Medicine at University of Colorado Denver.
Sepsis is a systemic infection of the body. One-third of patients admitted to hospitals with sepsis go into septic shock. Of those, half will die. In a 2016 study published in the American Journal of Respiratory and Critical Care Medicine, a team that included Schmidt and Linhardt developed a simple but accurate test for determining whether patients in septic shock would recover or die.
The test uses a urine sample to check concentrations of a type of sugar — glycosaminoglycans — that ordinarily coat cells lining blood vessels and other surfaces inside the body. In septic shock, the body sheds fragments of these sugars, and the team found that higher concentrations portend death. The test is used in clinical settings, and the insight has helped doctors search for more effective therapies.
Their next step tested whether a link exists between the sugars and mental aging associated with septic shock. Research published in the February edition of the Journal of Clinical Investigations showed that, during septic shock, fragments of the sugar heparan sulfate crossed the blood-brain barrier and entered the hippocampus, a region of the brain critical to memory and cognitive function. Evidence indicated that the heparan sulfate might be binding with brain-derived neurotrophic factor (BDNF), which is critical to hippocampal long-term potentiation, a process responsible for spatial memory formation. The researchers also found that presence of an enriched heparan sulfate in the blood plasma of septic patients upon admission to an intensive care unit predicted cognitive impairment detected 14 days after discharge.
To be sure, the researchers wanted to see the heparan sulfate enter the hippocampus and bind with BDNF. The new study in PNAS shows exactly that. To follow heparan sulfate into the brain in a sea of other sugars moving through the bloodstream Linhardt’s team had to synthesize heparan sulfate tagged with a stable carbon isotope, which unlike many other labeling methods, is completely safe and was identical to the natural sugar. It took them two years to figure out how to do it.
Then they put their hypothesis to the test. In healthy mice, 100 percent of the tagged heparan sulfated was excreted through the urine within 20 minutes, and none ever entered the brain. But in septic mice, researchers found a small amount of tagged heparan sulfate in the hippocampus region of the brain.
“Now that we know the cause of cognitive damage in septic shock, it gives us a clear target for a drug therapy: something that binds to the sugar and clears it, or an enzyme that converts it to something that won’t impair cognitive function,” Linhardt said. “This is an important advance, and we’re excited about the story that’s unfolding. “
Materials provided by Rensselaer Polytechnic Institute. Original written by Mary L. Martialay. Note: Content may be edited for style and length.
FAQs – Australian Sepsis Network
These are the answers to some of the most common questions we receive about sepsis, both from individuals and healthcare providers.
Sepsis is an illness that can happen in response to an infection and can quickly become life-threatening. It can affect all parts of the body.
In severe cases of sepsis, one or more organs fail. In the worst cases (known as septic shock), sepsis causes the blood pressure to decrease to dangerous levels and the heart to become weaker. Once this happens, multiple organs may fail quickly and, if not corrected, the patient will die.
Sepsis is a medical emergency that can be difficult to diagnose, and to treat.
What are the symptoms of sepsis?
Common symptoms of sepsis are fever, chills, rapid breathing, rapid heart rate, rashes, drowsiness, confusion, and disorientation, and not passing urine.
Many of these symptoms, such as fever and difficulty with breathing, are similar to symptoms of other conditions, like the flu. This makes it difficult to diagnose sepsis in its early stages, especially in hospitalised patients who will have other causes of those symptoms.
What causes sepsis?
Sepsis occurs when the body’s response to an infection becomes harmful. Infection causes your immune system releases chemicals into your blood to fight the infection.
These chemicals can cause generalised inflammation in the body making blood vessels leak and causing blood clots. These changes can damage all the body’s organs.
Almost any type of infections can lead to sepsis, this includes infections of the lungs, abdomen (such as appendicitis), urinary tract, skin, or other part of the body.
Infections acquired in hospitals or other healthcare settings (healthcare-associated infections), can also lead to sepsis.
Who gets sepsis?
Anyone can get sepsis, but the risk is higher in:
- People with weak immune systems
- Infants and young children
- Elderly people
- People with pre-existing illnesses, such as diabetes, AIDS, cancer, and kidney or liver disease
- People suffering from a severe burn or physical trauma
How many people get sepsis?
Each year around 18,000 people are treated in an Intensive Care Unit (ICU) in Australia and New Zealand for severe sepsis. The number of people treated for sepsis is increasing because:
- The population is aging
- More people have chronic illnesses
- More people are getting being treated with immunosuppressive drugs, chemotherapy, and organ transplants
- Bacteria are becoming more resistant to antibiotics
How is sepsis diagnosed?
Doctors will suspect sepsis from a number of physical symptoms like fever, increased heart rate, increased breathing, mental confusion or drowsiness. They will also do laboratory tests to confirm the diagnosis. These tests include a blood test to reveal if the number of white blood cells is abnormal (a common sign of sepsis), or tests to detect bacteria in the bloodstream or in urine. X-ray and scans may be performed to identify or confirm the source of the infection.
How is sepsis treated?
People with sepsis are treated in hospital and those with severe sepsis are usually treated in the intensive care unit. Treatment targets the infection, while supporting vital organs and giving intravenous fluids and drugs to maintain blood pressure.
In severe cases when organs fail, life-support treatments such as artificial ventilation (breathing machine) or kidney dialysis, may be necessary. Surgery may be needed to control a local site of infection such as in appendicitis or following a perforated bowel.
Are there any long-term effects of sepsis?
Many people who survive severe sepsis recover completely and return to normal lives.
Some people, especially those who have required prolonged treatment in an ICU may experience longer term problems including permanent organ damage.
Other longer term effects include difficulty sleeping, concentrating or returning to work, reduced energy and musculoskeletal problems.
What is being done to improve outcomes from sepsis?
Many government agencies, doctors, nurses and other healthcare providers are working to prevent sepsis and to improve the recognition and treatment of sepsis.
- Australian Commission on Safety and Quality in Health Care
- Healthcare Associated Infection (HAI) Prevention Program
- National Antimicrobial Stewardship Initiative
- National Hand Hygiene Initiatives
- National Infection Control Guidelines
- NSW Clinical Excellence Commission’s “Sepsis Kills” Program
- Better Care Victoria’s ‘Sepsis Improvement Project’
Blood test for sepsis in an adult
Sepsis: types, procedures, how to determine
Infectious blood poisoning, or, more precisely, sepsis, is a condition that really threatens a person’s life. In oncology, sepsis is the result of the penetration of pathogenic microorganisms into the human body. It is they that provoke the beginning of the production of biologically active substances, the so-called inflammatory mediators.
Our tissues and organs react very actively to this process, which is why inflammatory foci appear in different parts of the body. They also cause an imbalance in vital functions. As already noted, in such a situation, a lethal outcome is very possible.
It is important for an oncologist to pay special attention to diagnostic procedures and the treatment of sepsis, because it is he who quite often occurs in cancer patients. The risk group consists of operated patients who are in the therapy ward. It is even theoretically impossible to create ideal sterile conditions. And here the task of doctors is to apply the latest diagnostics of the disease and the ability to take the necessary measures to solve this problem.
Why there is
Sepsis is caused by microorganisms. These are parasites, fungi, bacteria, and viruses, which in most cases penetrate into the body from the external environment.
Sometimes sepsis develops from the natural flora of the body, this usually happens with an extremely reduced immunity.
Do not think that the very fact of infection penetration into our body initiates sepsis. There are additional factors leading to the generalization of this process.
Here we are talking primarily about the risk group:
- Age 75+;
- Diseases of a chronic nature;
- Operations performed;
- Availability of invasive devices;
- Long-term treatment in the clinic;
- Failure of the immune system due to illness or chemotherapy;
- Pregnancy, childbirth.
Types of sepsis
The classification of the disease is based on the localization of the primary focus:
- Primary sepsis;
- Secondary sepsis.
If in the primary it is impossible to establish the localization of the focus, then in the case of secondary sepsis, depending on its location, it is classified:
- Percutaneous. The focus is on the skin;
- Odontogenic. The cause of the occurrence is diseases of the dentoalveolar system;
- Otogenic. Inflammation in the ear;
- Gynecological sepsis. The focus is in the female genital organs;
- Surgical. Infection during surgery or invasive procedures.
When the test is ordered
It happens that the symptoms of sepsis are mild and resemble the manifestations of other diseases.
Symptoms that should alert the doctor and prescribe tests:
- Increased body temperature;
- Rapid breathing and contractions of the heart muscle;
- Profuse sweating;
- Signs of dysfunction of various organs.
In severe situations, the patient is observed:
- Confusion of consciousness;
- Decrease in blood pressure;
- Coldness in limbs, cyanosis;
- The appearance of spots on the skin.
An important reason to prescribe tests to detect sepsis is that previously conducted studies suggest blood poisoning.
As a rule, the quick SOFA (qSOFA) scale criteria are used for the study, where it is important to identify 3 criteria that summarize the presence of sepsis:
- Upper blood pressure below 100 mm Hg. Art .;
- Respiration rate up to 22 per minute;
- Change of thinking.
For a more accurate diagnosis, the criteria of the SOFA scale are used, which take into account the results of laboratory tests.
An international method for the quantitative diagnosis of bacterial toxins is the analysis of endotoxin activity (EAA). It is the only FDA approved method to date.
Endotoxin is a lipopolysaccharide by its chemical nature. It is a strong inflammatory mediator. And even at the initial stages of the development of sepsis, its level rises sharply.
An endotoxin level analysis is a blood sampling followed by the addition of unique antibodies to it, which, by binding to a bacterial lipopolysaccharide, absorb neutrophils.
Due to this, biochemical reactions begin in the cells and there is a rapid absorption and consumption of oxygen.
The intensity of the resulting luminescence, which is recorded by means of a luminometer, makes it possible to judge the level of endotoxin in the blood.
The result obtained during the study is evaluated from 0 to 1:
0 – no endotoxin;
less than 0.4 – the level is low;
0.4–0.59 – intermediate level;
0.6 and more – high level;
1 – critical level.
This analysis is straightforward.
Pros of the test:
- Fast results;
- Informative value;
- Identification of the risk of developing sepsis;
- Diagnosis of sepsis in its early stages.
Clinic Onco.Rehab has everything you need to carry out this test for sepsis.
Erythrocytes with sepsis
Red blood cells are blood cells that contain hemoglobin and are responsible for transporting oxygen and carbon dioxide.
With the development of sepsis in the later stages, they are destroyed. First of all, what happens:
- Anemia, i.e. hemoglobin decreases;
- Decrease in the number of erythrocytes;
- There is free hemoglobin, which activates the production of substances associated with inflammation;
- Reducing their deformation, and hence their main functions.
ESR with sepsis
ESR, or erythrocyte sedimentation rate (male rate 2-15 mm / hour, female 1-10 mm / hour.) increases with blood poisoning. This is a clear indicator that an inflammatory process is taking place in the body.
Leukocytes with sepsis
An increase in the number of leukocytes in the blood causes leukocytosis. The reason for the increase in these white blood cells is the development of the process of inflammation.
In some cases, a special type of leukocytes decreases, neutrophils leads to neutropenia. This is a deplorable symptom.
Platelets for sepsis
Thrombocytopenia caused by a decrease in the number of platelets in the blood is a clear symptom of the presence of sepsis.
The risk of death depends directly on:
- How much the patient’s platelet count is reduced;
- The timing of this state.
How to define sepsis?
With sepsis, mortality can reach 10 to 40%. It depends on several important factors:
- Type of pathogen;
- General health of the patient;
- Time of diagnosis and treatment initiation.
It happens that the inflammatory process proceeds in the form of septic shock, in which there is a violation of blood circulation, metabolic processes in cells, a significant drop in blood pressure. In this state, mortality reaches its maximum threshold.
Onco.Rehab integrative oncology clinic practices all types of sepsis treatment:
- Medicines capable of supporting vital functions;
- Infusion therapy;
- The latest devices for plasmapheresis, etc.d.
Clinic of integrative oncology Onco.Rehab: our partners do everything necessary for the early diagnosis of sepsis, we provide immediate assistance, we carry out resuscitation measures.
Sepsis-associated encephalopathy (review) | Beloborodova
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90,000 Get tested for the hormone procalcitonin
Interpretation of results
Interpretation of test results contains information for the treating physician and does not constitute a diagnosis.The information in this section cannot be used for self-diagnosis and self-medication. An accurate diagnosis is made by a doctor, using both the results of this examination and the necessary information from other sources: anamnesis, results of other examinations, etc.
Interpretation of the results of determining the level of procalcitonin in blood serum
Units of : ng / ml.
Alternative units : μg / L.
Conversion : ng / ml => μg / L.
Lower detection limit : 0.02 ng / ml.
Reference values :
- Newborns (up to 72 hours): Procalcitonin values at birth
90 025 90 024 children (from 3 days) and adults:
Interpretation of results
The level of procalcitonin increases with a clinically significant bacterial infection and increases with its severity. Individual severity of the immune response and different clinical circumstances can be associated with different degrees of increase in the concentration of procalcitonin.For informed therapeutic decisions, the result obtained should be interpreted in the context of an overall clinical assessment regarding the severity of the condition and the pretest likelihood of bacterial infection. Use of the test in relation to antibiotic therapy – see specific clinical guidelines / algorithms.
Information on the interpretation of results in the diagnosis of acute lower respiratory tract infections
Procalcitonin level less than 0.1 ng / ml – bacterial infection can be ruled out with a high probability.
Moderate increase (up to 2.0 ng / ml) – bacterial infection is possible:
0.1-0.25 ng / ml – unlikely;
0.25-0.5 ng / ml – likely;
> 0.5 ng / ml – highly likely.
Significant increase (above 2.0 ng / ml) – high probability of severe bacterial infection.
For stable patients with mild respiratory infections, procalcitonin levels below 0.25 ng / mL are suggested as grounds for refraining from antibiotics, with a recommendation for re-evaluation if the patient does not improve within 24-48 hours.
For critically ill patients admitted to intensive care units with suspected sepsis:
Reference values in healthy subjects:
Procalcitonin level – systemic infection (sepsis) unlikely. Localized bacterial infection is possible. Low risk of progression to severe systemic infection (severe sepsis). Attention! A level less than 0.5 ng / ml does not exclude infection, as localized infections (without systemic manifestations) may be associated with such low concentrations.If the appropriate measurement was made very early after the onset of infection (less than 6 hours), the level of procalcitonin should be re-examined after 6-24 hours.
Procalcitonin level from 0.5 to 2 ng / ml – systemic infection (sepsis) is possible, but other circumstances may serve as stimuli for the induction of procalcitonin (see below). Moderate risk of progression to severe systemic infection (severe sepsis). The patient’s condition should be closely monitored and the procalcitonin study repeated within 6-24 hours.
Procalcitonin level 2-10 ng / ml – Systemic bacterial infection (sepsis) is likely if there are no other known reasons for this increase (see below). High risk of progression to severe systemic infection (severe sepsis).
Procalcitonin level> 10 ng / ml is a significant systemic inflammatory response observed almost exclusively due to severe bacterial sepsis or septic shock. High likelihood of severe sepsis or septic shock.
In patients with septic shock, a decrease in procalcitonin levels of 80% or more in four days correlates with a more favorable outcome than a decrease of less than 80%. For critically ill patients with suspected sepsis, initial antibiotic use is not delayed, but procalcitonin levels below 0.5 ng / ml or a decrease of more than 80% of the peak increase are suggested to be considered as evidence in favor of stopping antibiotics as soon as the condition the patient is stabilized.
An increase in the concentration of procalcitonin is not always associated with systemic bacterial infection. Increases in procalcitonin levels due to non-bacterial causes include but are not limited to:
- physiological increase in the first 48 hours in newborns;
90,024 the first days after significant inflammatory stimuli of a non-infectious nature (severe trauma, burns, major surgical interventions).Values above 2 ng / ml are noted in about 8% of cases after heart and lung operations and in almost a quarter of patients after bowel operations. Values above 10 ng / ml practically do not occur in the normal course of the postoperative period, but were noted in 92% of situations with the development of complications. In the case of a non-infectious increase in the level of procalcitonin in such situations, it is expected to decrease after 24-48 hours;
90,024 in patients with malaria;
Viral infections, autoimmune diseases, chronic inflammatory processes rarely lead to an increase in the level of procalcitonin more than 0.5 ng / ml.
A low level of procalcitonin does not always rule out the presence of a bacterial infection. A low concentration of procalcitonin is possible at an early stage of bacterial infection, with localized infections, with subacute infective endocarditis.
The patient’s serum rheumatoid factor (RF) may react with the immunoglobulins of the reagent and interfere with the test.Samples from patients receiving mouse monoclonal antibody drugs for diagnosis or therapy may contain human antimurine antibodies (HAMA). Such samples can cause interferences, which can manifest themselves as a falsely increased or falsely low result in the determination of procalcitonin, since murine monoclonal antibodies are used in the reagents used for the study.
Use with caution in patients with immunosuppression (including HIV), cystic fibrosis, pancreatitis, trauma, malaria, transfusion of large amounts of blood, in pregnant women.The procalcitonin test algorithm should not be used in patients with chronic infections (such as abscess, osteomyelitis, endocarditis).
If the result of the study does not correspond to the clinical data, it is recommended to conduct additional studies.
The result of a study of procalcitonin cannot serve as the only basis for making decisions on prescribing / discontinuing antibiotics.Use of the test in relation to antibiotic therapy – see specific clinical guidelines / algorithms.
What is sepsis – its symptoms, consequences, causes and treatment
Updated July 23, 2021
- Sepsis – what is this disease
- Where does it come from
- How does the septic process develop
- Symptoms and signs of sepsis
- What to do if you have symptoms
Hello, dear readers of the blog KtoNaNovenkogo.ru. In medicine, it is customary to use terms. The meaning of compound words is clear to doctors, but rarely familiar to patients, although both occur frequently.
Today we will try to understand the term “sepsis”. What is this disease, how is it manifested and how is it treated?
Sepsis – what is this disease and what are its consequences
Translated from the ancient Greek “sepsis” is rotting. This refers to the general (systemic) response of the body to a severe infection. It is also called blood poisoning , systemic inflammatory response syndrome, bacteremia, septic syndrome.
It turns out that instead of local (local) inflammation in response to infection , the whole body “inflames”, and microbes enter the bloodstream. The main danger is the spread of microorganisms throughout the body.
As a result, the dissemination (spread) of microbes leads to disruption of the work of internal organs (SPON or SPOD – syndrome of multiple organ failure or dysfunction).
Where does sepsis come from?
Any infectious disease can lead to the development of sepsis.Usually, blood poisoning is caused by pyogenic bacteria , less often – by other bacteria, even less often – by fungi, parasites, viruses.
Often a septic condition develops from wounds on the skin or other foci of infectious inflammation. Such infections are almost always caused by cocci (streptococci, staphylococci, pneumococci and others), Escherichia coli. These bacteria are common – they live on the skin, in the nose and mouth, in the digestive system of every person.
Sepsis usually occurs in patients with scarlet fever, angina, pneumonia, in newborns and in women in labor, with boils and phlegmon, bacterial infections of the kidneys and urinary system.
These, like many others, are diseases of organs that are well supplied with blood . Such diseases are more likely to give septic complications.
How the septic process develops
Septic conditions always begin from an already existing focus of infection. They occur either when a chronic infection is exacerbated, or when a new inflammatory process appears.
At each point of contact with microbes immunity protects the body from the spread of the process.For this, inflammation begins in the focus – a reaction that improves local blood circulation.
So, many leukocytes (from ancient Greek – white cells) – immunity cells that protect a person from getting microbes into him – are sent to a specific point.
Leukocytes themselves can fight bacteria, fungi and other foreign cells directly. To fight viruses, they produce many molecules that prevent the virion (viral particle) from living in human tissues.
Most infections remain local and do not spread throughout the body.Often, infectious diseases pass with intoxication syndrome: the temperature rises, general weakness and malaise, lack of appetite, and nausea appear.
Some diseases occur with the movement of the pathogen through the blood, but sepsis is not caused. And only in rare cases due to the coincidence of circumstances does a septic state begin.
In the event that microbes enter the circulatory system, they can be transferred with the blood stream to neighboring or distant organs.
Purulent processes in vital internal organs sharply worsen a person’s condition: septic endocarditis leads to disruption of the heart, brain damage – encephalitis, meningitis (what is it?) Or simultaneous meningoencephalitis, impaired blood circulation in the skin leads to minor bleeding, and so on Further.
For sepsis, it is important that the complex circuitry of the immune system fails. Such problems can be caused by the waste products of microbes – toxins.
Some bacteria are capable of producing exotoxins – proteins specially created to damage the host. All pathogenic (disease-causing) bacteria have endotoxins – protein substances that are released only after cell death, but also harm human cells.
Symptoms of sepsis – how it manifests
The main manifestation (symptom of sepsis) is systemic inflammatory response syndrome (SIRS, in English – SIRS, systemic inflammatory response syndrome).
It is assessed using a simple scale: pulse (heart rate, heart rate), respiration, temperature and blood test result. More than exact numbers :
- Heart rate more than 90 beats per minute;
- respiratory rate is more than 20 per minute;
- body temperature more than 38 ° C or less than 36 ° C;
- The number of leukocytes in the clinical blood test is more than 12 × 109 / l or less than 4 × 109 / l.
If at least two of the four criteria are present in a person, doctors talk about the development of SIRS. This is the first sign of the onset of sepsis.
Development begins with a sharp rise in temperature to 39-40 ° C and more, health worsens, there are punctate subcutaneous bleeding, blood pressure decreases, breathing and heart rate increase.
At the same time the first focus of infection becomes more pronounced:
- if it is a wound on the skin – pain, burning, swelling increases;
- angina – the tonsils swell, pain at rest and when swallowing also increases;
- pyelonephritis – the same soreness and dysfunction of the organ.
Body temperature can fluctuate with sharp drops to normal values, but then it will rise again.
In the most severe cases, consciousness begins to suffer (from an inhibited reaction to its complete loss, coma), kidney function (the volume of urine decreases), liver (all its functions suffer). Multiple organ failure developing without treatment can lead to death.
What to do if there are symptoms of sepsis
Treatment of sepsis is the task of anesthesiology and intensive care units, i.e. intensive care units .
The human condition can deteriorate sharply at any time, therefore, constant careful monitoring of vital signs is needed.
The main goal of treatment is antimicrobial therapy simultaneously with the elimination of all symptoms. Usually, antibiotics or other antimicrobial agents are used to combat the cause and are given intravenously.
Symptomatic treatment includes detoxification, control of the heart (pressure, frequency and efficiency of contractions), respiration (usually people are connected to artificial respiration), correction of electrolyte and cellular blood disorders.
The patient must be taken to the hospital as soon as possible. Statistics say that for every hour delay in starting treatment increases the risk of death by 5-10% !
Sepsis – is a serious complication of an infectious disease that occurs when a microbe enters the bloodstream. In response to this, a general inflammatory process begins in the body. As a result, the work of internal organs may be disrupted, due to which some patients die.
It develops after the onset of any infection, but is usually purulent wounds, tonsillitis and similar processes in internal organs.
An altered immune response worsens the infection, which ultimately turns into the appearance of inflammatory foci in the internal organs. Thus, multiple organ failure can begin, which can lead to death.
Early treatment significantly improves the chances of recovery. The patient should be treated in the intensive care unit, where sepsis and its cause will be treated with the correct antibiotics and drip solutions.
Article author: pediatric surgeon Sitchenko Victoria Mikhailovna
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This article belongs to the headings:
Manager MakSim answered rumors about sepsis in the singer
Photo: Ekaterina Chesnokova / RIA Novosti
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Manager and official representative of the singer Marina Abrosimova, known as MakSim, Yana Bogushevskaya responded to rumors about the development of sepsis in the singer.She doubts that the singer’s friends have exclusive information from doctors, reports Lenta.ru.
When Marina’s friends give interviews, they at least introduce themselves, this is the first thing. Secondly, no friends have access to doctors, I say this for sure , – said Bogushevskaya.
Representatives of the artist said earlier that the statement of “friends”, “colleagues” and “relatives”, who do not even introduce themselves, cannot be trusted.All information about MakSim’s health now comes from Bogushevskaya and the director of the singer Margarita Sokolova.
A previously unnamed girlfriend of the performer said in an interview with KP.RU that the artist was again in critical condition. She underwent a CT scan of the lungs and a blood test, as a result of which it became clear that she had a strong purulent-inflammatory process in her lungs. Doctors are fighting for her life and trying to alleviate her condition. According to her friend MakSim, “apparently, sepsis has begun.”
The singer was hospitalized on June 16 and three days later was connected to a ventilator because she could not breathe on her own.On July 10, PR manager MakSim Yana Bogushevskaya announced that the artist’s condition had improved. Doctors made an attempt to disconnect the singer from ECMO, but she could not breathe on her own and was reconnected to the device.
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A study aimed at identifying the level of procalcitonin in the blood for the diagnosis of sepsis, septic complications, severe bacterial infections and purulent-inflammatory processes.
Procalcitonin; biological marker procalcitonin.
Procalcitonin; PCT; biomarker.
Ng / ml (nanogram per milliliter)
Which biomaterial can be used for research?
How to properly prepare for the study?
- Eliminate alcohol from the diet within 24 hours before the study.
- Children under the age of 1 year do not eat for 30-40 minutes before the study.
- Children aged 1 to 5 years should not eat for 2-3 hours before the study.
- Do not eat for 8 hours before the study, you can drink clean non-carbonated water.
- Eliminate physical and emotional stress for 30 minutes before the study.
- Do not smoke within 30 minutes prior to examination.
General information about the study
Procalcitonin is a prohormone, a precursor of the hormone calcitonin, which is involved in calcium metabolism and maintains a constant level in the blood. The polypeptide procalcitonin consists of 116 amino acids and is synthesized by the C-cells of the thyroid gland. Normally, its amount is extremely small and is found in the blood in trace amounts.
In the presence of a bacterial infection, exposure to toxins increases the extrathyroid synthesis of procalcitonin by neuroendocrine cells of the liver, kidneys, lungs, muscle tissue, adipocytes, which leads to a significant increase in its level. With a systemic inflammatory response, under the influence of pro-inflammatory molecules – endotoxin, interleukins-1 and 6, tumor necrosis factor alpha – the synthesis of procalcitonin in macrophages and monocytic cells increases. The production of this biomarker can increase during the first 2-4 hours, reaching a maximum after 12 hours, the half-life is 22-26 hours.It should be noted that with a viral infection, the synthesis of procalcitonin is absent or suppressed.
The advantage of determining procalcitonin is that its synthesis in a systemic inflammatory response reaches high levels earlier than other acute phase proteins. The syndrome of a systemic inflammatory response or reaction is characterized by a change in body temperature of more than 38 ° C or less than 36 ° C, an increase in the heart rate of more than 90 beats per minute, an increase in the respiratory rate of more than 20 per minute, a change in the number of leukocytes in the blood (less than 4 × 10 90 965 9 or more 12 × 10 9 cells per liter of blood) or a shift of the leukocyte formula to the left.
In addition to bacterial agents, severe infections caused by fungal infections and protozoa can lead to an increase in its content. In patients in intensive care units, the determination of this marker is important in severe infectious processes of various localization. In particular, with severe bronchitis, pneumonia, pancreatitis, appendicitis, peritonitis. Local inflammatory process – tonsillitis, pharyngitis, sinusitis, gastritis and others – do not lead to a diagnostically significant increase in the level of procalcitonin.
An important diagnostic value is an increase in the concentration of procalcitonin in multiple organ failure syndrome, sepsis, shock, especially in newborns and children. The highest values are observed in sepsis, septic shock, septicemia, meningitis. Also, the levels of this biomarker increase after major surgical interventions, operations under cardiopulmonary bypass, multiple injuries, severe burns, acute graft rejection, subarachnoid hemorrhage, and chronic heart failure.In severely ill patients, the levels of procalcitonin correlate with the severity of the pathological process, mortality after illness.
Along with the assessment of the clinical course of the disease, the data of laboratory and instrumental research methods, the detection of the level of procalcitonin can be used to determine the effectiveness of antibiotic therapy, as well as to determine the moment to stop this treatment. In patients with viral infections, allergic, autoimmune diseases, an increase in the concentration of procalcitonin occurs only in the case of a secondary bacterial infection.
What is the research used for?
- For the diagnosis of sepsis, septicemia, septic shock;
- For the diagnosis of systemic inflammatory response syndrome;
- For the diagnosis of multiple organ failure syndrome;
- For the diagnosis of severe bacterial infections of various localization;
- For the diagnosis of infectious complications in patients of surgical departments and intensive care units;
- For prescribing and monitoring the effectiveness of antibiotic therapy in patients with infectious and purulent-septic diseases.
When is the study scheduled?
- If you suspect sepsis, septic shock, the development of a systemic inflammatory response syndrome, multiple organ failure syndrome;
- For symptoms of severe infectious, purulent-inflammatory processes of various localization;
- If you suspect the development of a generalized bacterial infection in adults, children and newborns;
- If you suspect the development of infectious complications in patients in the conditions of surgical and intensive care units;
- If you suspect a secondary bacterial infection in patients with viral infections, allergic, autoimmune diseases;
- After major surgical interventions, operations in conditions of artificial circulation, multiple injuries, with severe burns, acute graft rejection, subarachnoid hemorrhage, with chronic heart failure;
- When prescribing and monitoring specific antibiotic therapy.
What do the results mean?
Reference values: 0 – 0.046 ng / ml.
> 2.0 ng / ml – a high likelihood of severe sepsis and / or septic shock.
Reasons for the increase:
- Sepsis, septicemia, septic shock;
- Neonatal sepsis;
- Systemic inflammatory response syndrome;
- Multiple organ failure syndrome;
- Infectious processes of various localization: severe bronchitis, pneumonia, pancreatitis, appendicitis, peritonitis; meningitis;
- Severe infections caused by fungal infection, protozoa;
- Extensive surgical interventions, operations in conditions of artificial circulation;
- Multiple injuries, burns;
- Acute graft rejection;
- In newborns in the first 2-3 days of life after birth.
Reasons for downgrade:
- Normal levels of procalcitonin can be observed in viral infections, allergic, autoimmune diseases, and local inflammatory processes.
What can influence the result?
- Use of drugs: immunosuppressants, hormonal drugs.
Download an example of the result
- When interpreting the results of the study, it is necessary to take into account the clinical picture of the disease, the presence of concomitant diseases and complications, the use of antibiotic therapy.
- In newborns, the level of procalcitonin increases in the first 12 hours after birth, reaching a maximum within 24-36 hours, decreasing to normal levels by 4-5 days after birth. In this regard, it is recommended to repeat the study after 24 hours to exclude generalized bacterial infection, neonatal sepsis.
- The use of drugs, in particular immunosuppressants, which increase the synthesis of proinflammatory cytokines, may increase the concentration of procalcitonin.
[02-029] Clinical blood test: general analysis, leukocyte formula, ESR (with microscopy of a blood smear when pathological changes are detected)
[02-025] Leukocyte formula (with microscopy of a blood smear when pathological changes are detected)
[02-006] General urine analysis with microscopy
[06-182] C-reactive protein, quantitative (method with normal sensitivity)
Who orders the study?
Doctor – anesthesiologist-resuscitator, surgeon, oncologist, obstetrician-gynecologist, pediatrician, therapist, cardiologist, infectious disease specialist.