Stopping sepsis in its tracks

Sometimes the most curious bit of information on someone's death certificate is why they died. For example, when the cause of death listed is an infection — such as pneumonia, COVID, flu, or another type — looks can be deceiving. By the time an infection kills someone, their death may actually be due to a larger, under-recognized phenomenon: sepsis.

"Many experts would argue that anytime someone dies from infection, the mechanism is basically through sepsis," says Dr. Chanu Rhee, medical director of infection control at Harvard-affiliated Brigham and Women's Hospital and an internationally renowned sepsis expert. "It's probably true in the vast majority of cases."

Shocking toll

Sepsis causes or contributes to an estimated 20% of all deaths worldwide, making it one of the leading causes of fatality. In the United States, more than 1.7 million adults develop sepsis each year, and 350,000 die from it, according to the CDC.

Despite its shocking toll, many people still don't know what sepsis is, Dr. Rhee notes. It's often referred to as a blood infection, but that can be misleading. Sepsis can result from any infection that overactivates the body's immune system, spurring it to release a torrent of inflammatory chemicals throughout the body.

"I usually describe it as a severe infection that causes the body to generate an extreme immune response that causes organ failure," he explains.

Older adults vulnerable

One of the challenges of measuring the health burden of sepsis is that any bacterial, viral, or fungal infection can lead to it. But some particular infections are more likely to do so, Dr. Rhee says, including those that begin in the lungs, urinary tract, gastrointestinal tract, or skin and other soft tissues.

Certain people are more vulnerable, too. Adults 60 and older account for two-thirds of sepsis cases and deaths, and most people who develop sepsis have at least one underlying condition, according to the CDC.

Equal-opportunity threat

"Our immune system tends to not work correctly as we get older, and sepsis also tracks with chronic diseases that are more common in older people — things like diabetes, chronic lung disease, and cancer," Dr. Rhee says. "We also tend to undergo more surgeries and procedures as we age that open up the skin and increase our risk of infection."

But sepsis can happen in anyone. Younger, previously robust people can also be stricken. "It's certainly the minority," he says, "but even if you're perfectly healthy, you can develop sepsis."

Avoidance strategies

The good news is that sepsis may be avoidable, and stopping bacterial, viral, or fungal infections from taking hold or worsening is a step in the right direction. You can do that by

• properly managing chronic conditions
• getting recommended vaccines
• taking antibiotics as prescribed to combat bacterial infections
• practicing good hand hygiene
• avoiding people who are sick
• keeping cuts and wounds clean
• practicing food safety measures by steering clear of raw or undercooked meat and poultry, raw fish, and unwashed fruits and vegetables.

Danger signs

Another crucial step to combat sepsis is by seeking medical attention if you notice potential signs such as fever, productive cough, redness around a cut or incision, pus or discharge from an open wound, or increased pain. You may also feel plain lousy.

Clinicians look for various signs to diagnose the condition — which often requires intensive care — including fever (or sometimes low body temperature), confusion or disorientation, shortness of breath, elevated heart rate, and low blood pressure, "one of the cardinal signs of sepsis," Dr. Rhee says. However, no single sign or medical test can confirm or exclude sepsis.

"When infection signs do develop, it's vital to get appropriate care in a timely fashion, particularly if you have risk factors for sepsis," Dr. Rhee says.

"That's the other half of the equation — let's jump on an infection before it progresses to full-blown sepsis. It's clear that the quicker treatment begins, the better people's outcomes tend to be."

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