Sepsis is dangerous. But if treated early, the patient outcome is usually favorable.
By Jim Poggi
Awareness of sepsis as a specific clinical condition has dramatically improved in the past 10 years due to the diligent efforts of the Sepsis Alliance and a large number of other advocacy groups from both clinical and laboratory disciplines. What we know today is that sepsis is the leading cause of death related to hospitalization and costs the U.S. healthcare system more than $24 billion annually. It’s the costliest single clinical condition in hospitals. Additionally, sepsis can be caused by a range of infections, many of which we typically consider relatively benign and easily treated. These causes include respiratory infections such as pneumonia, group A strep and influenza (more on this later), urinary tract infections, enteric diseases including C. difficile and skin infections including MRSA.
As a final note of review, sepsis is NOT a disease, and it’s not contagious. It’s defined as “the body’s overwhelming response to infection, which can lead to tissue damage, organ failure, amputations and death.” From a metabolic standpoint, sepsis typically unleashes a powerful immune response, resulting in what is described as a “cytokine storm.” Cytokines are a part of the immune system that pass messages to the immune system to attack a foreign substance and rid the body of it. In healthy conditions, their signaling stays in control and results in removal of the infecting substance. But in sepsis, their signal goes out of control and unleashes a far greater immune response than is appropriate.
As dangerous as sepsis can be, if diagnosed and treated early and aggressively, the patient outcome is usually favorable. More than 70% of those who suffer from sepsis will recover fully if treated promptly. The key is recognizing the symptoms of sepsis and rapidly taking action to overcome it.
Clinicians frequently use the acronym TIME when they describe the symptoms of sepsis. It’s worth putting into your vocabulary. The classic symptoms of sepsis include:
- Temperature: elevated or below normal.
- Infection: sepsis typically presents as a result of an infection.
- Mental confusion/decline: the patient may be sleepy, easily confused, or difficult to rouse.
- Extremely ill: patients frequently state that they are concerned they may die.
Sepsis amid the pandemic
So, how does sepsis fit into the world we live in today, with the COVID-19 pandemic an everyday concern? Unfortunately, with the widespread incidence of COVID-19, it’s amplifying the number of cases of sepsis worldwide. While any respiratory infection can lead to sepsis, the widespread incidence of COVID-19 has created far more opportunities for the development of sepsis. We are still learning to understand all the associated comorbidities related to the development of COVID-19 infections, but it’s becoming very clear that COVID-19 can unleash the classic “cytokine storm” typically associated with sepsis. In addition, its attack on the lungs and other organs complicates treatment and accelerates the urgency to treat it as well as to manage any associated comorbidities, including sepsis.
How does all this impact us and the customers we serve? Many of us work in primary care, rather than the hospital market. As a result, our clinicians may see a patient in the early stages of COVID-19 and then pass along those most acutely ill to an appropriate tertiary care facility. Post recovery, our customers will also engage with the patient to assure their complete recovery.
We have a role in the early diagnostic side of things and also in post recovery care of the patient. To be effective consultants, we need to be alert to the possibility of sepsis accompanying a COVID-19 infection. Those of us who call on urgent care and free-standing emergency centers are likely to have customers seeing more patients who present with sepsis. Over the past year, we have become well acquainted with the tests appropriate for diagnosis of COVID-19 including RT-PCR, antigen tests and COVID-19 antibody tests. Working with our key lab suppliers, we can now also present the facts about appropriate screening and diagnostic tests that can be performed in any setting, including the physician office to assist in diagnosis of sepsis related to COVID-19. These tests include lactate, procalcitonin, CBC, monocyte distribution width and interleukin-6 (IL-6). As we know early diagnosis is key to rapid, effective patient treatment and presents the best opportunity for full recovery. TIME is of the essence.
In the post recovery world, our customers need to be alert to identify any residual organ damage that may have resulted from sepsis. Here again, we have a key role to play. Our diagnostic arsenal includes virtually every lab test available to assess organ health, including ALT, AST, creatinine, urea nitrogen and CBC. There’s growing evidence that COVID infections have wide ranging organ impact, including the heart, so there may be a broader range of assays post COVID-19 than those typical of patients with sepsis unrelated to COVID-19. Be sure to work closely with your key lab supplier to know the facts about appropriate diagnostic tests as well as those appropriate for patient follow up post sepsis.
So, once again COVID-19 presents us with both challenges and learning opportunities. It has opened up our eyes to the need to test for IL-6 as an indicator of an impending cytokine storm, a learning we can use for every incidence of sepsis. It has also increased awareness in the clinical community and even with the general public that respiratory infections can and do have a range of systemic impacts and may affect many organs. The clinical community has benefitted from the experience gained in treating COVID-19 patients that will have far-reaching impact on diagnosis and treatment of sepsis and respiratory infections in general. While the COVID-19 pandemic has been a difficult and continuing challenge, it has presented all of us with opportunities for growth. The knowledge we have gained leads us to be better and more well-informed consultants.