Sepsis: Life-Threatening but Hard to Spot

Consider sepsis an invisible threat. It kills about 350,000 Americans a year and may cause nearly one-fifth of deaths globally. But you won’t find it on any “leading causes of death” lists.

That’s because sepsis starts as something else: infections in places such as the lungs, skin and urinary tract that usually resolve with no problem. But when your body mounts an extreme response to that infection, damaging organs in the process, it means you have sepsis.

Adding to the stealth of sepsis, early symptoms are often vague and hard to identify, and people don’t know what they’re experiencing until they get sicker.

“There’s not a classical presentation like a heart attack or stroke, and it can be very subtle,” says UNC Health critical care physician Francis Castiller, MD, who treats sepsis in the intensive care unit at UNC Rex Hospital.

What Is Sepsis, and Who Gets It?

When we get infections, it’s because an invading pathogen, usually a virus or bacteria, has entered the body. In response to the invader, the immune system releases cells to fight the threat. The cells contain “inflammatory mediators” that attack the pathogen.

“Sometimes these inflammatory mediators are so overreactive that they actually harm our own organs,” Dr. Castiller says.

Almost any infection, from a cut in the skin to COVID-19, can lead to sepsis. Most commonly, sepsis starts with infections in the lung, urinary tract, skin or gastrointestinal tract.

Anyone can get sepsis, but people age 65 and older, people with compromised immune systems and those with significant comorbidities, such as vascular disease or diabetes, are at greatest risk. Babies younger than 1 are also at higher risk of sepsis.

If sepsis is not treated with antibiotics or the drugs don’t work, it can progress to septic shock, when blood pressure drops dangerously low and organs begin to fail. The risk of death from sepsis without shock is about 12 to 15 percent; with shock, it’s as high as 45 percent, Dr. Castiller says.

Sepsis is not an infection you “catch” in the hospital, but 1 in 3 patients who die in a hospital had sepsis. Sepsis is that common and that deadly.

Treat Sepsis Fast to Survive

The key to surviving sepsis is to treat it early, which can be difficult both because of a lack of awareness and because sepsis doesn’t cause the same symptoms for everyone, Dr. Castiller says.

“There’s not one easy symptom to point to,” he says. “I always tell people, if your loved one does not look right, does not seem right, whatever that means, call a provider and get evaluated quickly. Early recognition makes the biggest difference in sepsis.”

For babies, it’s the same idea: If your child isn’t eating or sleeping normally or seems lethargic, contact your pediatrician right away.

Doctors should suspect sepsis if two of three conditions are met, Dr. Castiller says: low blood pressure, rapid breathing and confusion.

Treatment is antibiotics and IV fluids to improve organ function. Sometimes doctors need to use more than one antibiotic.

If your loved one has an infection that isn’t improving, don’t be afraid to ask their doctor or nurse whether sepsis is a possibility, Dr. Castiller says.

Life After Sepsis

Sepsis takes a toll on the body that can linger even after the infection has cleared. Survivors can experience physical and mental symptoms including weakness, fatigue, trouble sleeping, anxiety and depression.

Depending on the course of a person’s illness, their affected organs might not work as well as they did before. For example, a person who had sepsis from a kidney infection might have chronic kidney problems going forward.

Fortunately, “for most people, the organ dysfunction is reversible,” Dr. Castiller says.

Sepsis survivors often benefit from rehabilitation and physical therapy. For those with mental health effects, including symptoms of post-traumatic stress disorder, seeing a psychologist can be beneficial.

It’s important for survivors to know that they’re at increased risk of experiencing sepsis again, Dr. Castiller says.

“We need to keep up efforts to increase awareness so we can recognize and treat sepsis early,” he says. “That is the most effective way to save lives.”

If you have questions about your health, talk to your primary care provider. If you need a doctor, find one near you.