Sepsis is the number-one cause of preventable death in the world. Around 11 million people per annum die from sepsis globally, accounting for one in five of all deaths worldwide. In the UK alone, around 50,000 people a year are killed by the condition – more than the total combined number of deaths due to breast, bowel and prostate cancer.
Sepsis is an indiscriminate condition that can kill a previously healthy adult in a matter of hours, despite advances in vaccines, antibiotics and intensive care. “Essentially, sepsis occurs when the body’s reaction to infection is so severe that the organs start to fail as a result,” explains sepsis specialist Dr Andrew Conway Morris, Medical Research Council Clinician Scientist, University of Cambridge.
“In cases of sepsis, a patient has an underlying infection that provokes an inflammatory response from the body's own immune system, which then starts to harm the patient's own organs so that they become impaired. Obviously, if this were to continue and not be arrested, then the outcome would be the death of the patient.”
Diagnosing sepsis and ensuring early treatment can prove difficult, as it is often hard for doctors to distinguish sepsis from other infections. This is partly because of the broad range of organ systems that can be affected – including the lungs, heart, liver and kidneys, as well as the brain and the skin. “It is often difficult to pin down what is driving the problem until it becomes very obvious, by which time it is almost unstoppable,” says Dr Conway Morris.
“The key to tackling sepsis successfully is to identify it and begin treatment as soon as possible, but at the early stages it can be subtle in its appearance and challenging to detect. The important thing is to recognise that sepsis is an emergency. A patient can go from feeling pretty well to very sick in just a few hours.”
Establishing precisely how and why people get sepsis is the subject of ongoing and extensive research, as specialists seek to identify those who may be most prone to developing the condition. “We know that people at the extremes of age – the very young and the elderly – are at greatest risk, but it is important to recognise that sepsis can hit people at any stage of their lives,” says Dr Conway Morris. “Also, some people will be predisposed towards having a particularly vigorous response to a specific pathogen, a particular bug that is causing their illness, and that will make them susceptible to sepsis.”
As well as age and genetics, other factors can play a role. “If a patient’s immune system is already impaired, perhaps because of their current medication or other medical issues, then an infection that other people might shrug off – for example, pneumonia or an infection in soft tissues from an insect bite – can suddenly become very serious.”
Although there is a common perception that hospital patients have a greater likelihood of sepsis, Dr Conway Morris is eager to point out that the reality is more complex. “Patients in hospital can acquire infections and become at risk of developing sepsis,” he says. “However, it is important to emphasise that many hospital patients who develop sepsis are there because they already had an infection, not that their infection was caused by being in hospital in the first place.”
Treatment for sepsis depends on the underlying infection, with at least 70%
of cases being caused by bacteria. “If it's a bacterial infection then antibiotics would be the appropriate treatment. Other infections, such as viruses, can also be a cause. During the pandemic, many of those who contracted severe Covid-19 also had sepsis,” says Dr Conway Morris. “Fungal infections are another potential cause, particularly in those who already have an impaired immune system.”
UK-based charity Sepsis Research FEAT is among the organisations leading research into the diagnosis and causes of sepsis and treatments for the condition. Founded in 2013 as the Fiona Elizabeth Agnew Trust (FEAT) by Craig Stobo, after he lost his wife and unborn daughter to sepsis, the charity is currently conducting a research prioritisation exercise. This involves asking sepsis survivors, carers, healthcare professionals and the wider public what they consider to be the major issues around sepsis. Such feedback will then inform future research efforts.
Additional areas of research include recording the changes that occur in the immune system and exploring genetic predispositions towards sepsis. Information from these studies will help in identifying patients at higher risk and finding new treatments. “It’s important to remember that sepsis is not a single disease, but instead a syndrome with lots of complex underlying physiology, and that we really need to get to the bottom of this to make progress,” comments Dr Conway Morris. “We’re still at the early days of understanding sepsis and we’ve got a long way to go.”
Looking ahead, Dr Conway Morris is encouraged by recent developments in detecting microorganisms and the prospects for speeding up the diagnosis of sepsis. “I think we will see such technology entering the clinical mainstream over the next decade, enabling us to identify the bugs that are causing sepsis infections much more quickly and accurately,” he predicts. “Infections are part of everyday life, so the dream scenario would be to identify people with infections as early as possible, in order that we can give them the right treatments to prevent organ failure, or to turn things around much faster if sepsis were to develop.”
Sepsis represents a major public health problem in all countries, regardless of their wealth, but the burden is greatest in low- and middle-income countries that have the least resources. “I would love to see existing technologies and techniques made widely available to everyone who needs them around the world, not just in richer countries,” says Dr Conway Morris.
“Relatively modest investments in lower-income economies could make a massive difference to sepsis treatment that would save many lives. Such action would also benefit us all, helping to reduce antibiotic use in such countries and assisting global efforts in the fight against antimicrobial resistance.”
- Very high or low temperature
- Uncontrolled shivering
- Confusion
- Passing less urine than usual
- Blotchy or cold arms or legs
Other symptoms may include: fast or difficult breathing, rapid heartbeat, feeling dizzy or faint, vomiting and diarrhoea.
On their own, each of these symptoms can be an indication of other health problems that may still require medical attention. But a combination of these symptoms, becoming progressively worse, means you need to seek urgent medical attention. Early recognition and prompt treatment can and does save lives.
Sepsis Research FEAT
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Sepsis Research FEAT relies on the generosity of supporters to fund its sepsis research and awareness campaigns. To make a donation, please visit:
sepsisresearch.org.uk/sepsis-donation/
Sepsis Research (FEAT) SCIO is a registered charity SC049399
