(in
Greek ''Σήψις'', putrefaction) is a serious medical condition caused by a severe
Infection . The more critical subsets of sepsis include severe sepsis (sepsis with acute organ dysfunction) and
Septic Shock (sepsis with refractory arterial
Hypotension ). If a proven source of infection is lacking but the other criteria of sepsis are met the condition typically meets the criteria for
Systemic Inflammatory Response Syndrome (SIRS); the exception is the condition ''greater than 10% band forms'' (this is not a part of the SIRS definition).
is sepsis of the bloodstream caused by
Bacteremia , which is the presence of bacteria in the bloodstream. The term ''septicemia'' is also used to refer to sepsis in general.
The systemic inflammatory response leads to widespread activation of
Inflammation and
Coagulation pathways. This may progress to dysfunction of the
Circulatory System and, even under optimal treatment result in the
Multiple Organ Dysfunction Syndrome and eventually
Death .
Sepsis is common and also more dangerous in elderly, immunocompromised, and critically ill patients. It occurs in 2% of all hospitalizations and accounts for as much as 25% of
Intensive Care Unit (ICU) bed utilization. It is a major cause of death in intensive care units worldwide, with mortality rates that range from 20% for sepsis to 40% for severe sepsis to >60% for
Septic Shock . In the
United States , sepsis is the leading cause of death in non-coronary ICU patients, and the tenth most common cause of death overall according to 2000 data from the
Centers For Disease Control And Prevention .
A problem in the adequate management of septic patients has been the delay in administering the right treatment after sepsis has been recognized. A large international collaboration was established to educate people about sepsis and to improve patient outcomes with sepsis, entitled the "Surviving Sepsis Campaign." The Campaign has published an evidence-based review of management strategies for severe sepsis, with the aim to publish a complete set of guidelines within 3 years.
Sepsis can be diagnosed if infection is proven by means of a positive
Blood Culture and two or more of the following:
- Heart Rate > 90 beats per minute
- Body temperature < 36 (96.8°F) or > 38°C (100.4°F)
- Hyperventilation (high respiratory rate) > 20 breaths per minute or, on Blood Gas , a PaCO2 less than 32 Mm Hg
- White Blood Cell count < 4000 cells/ Mm³ or > 12000 cells/mm³ (< 4 x 109 or > 12 x 109 cells/ L ), or greater than 10% band forms (immature white blood cells).
When two or more of these clinical parameters are met without confirmation of infection it is called systemic inflammatory response syndrome.
The therapy of sepsis rests on
Antibiotic s, surgical drainage of infected fluid collections, fluid replacement and appropriate support for organ dysfunction. This may include
Hemodialysis in
Kidney failure,
Mechanical Ventilation in
Pulmonary dysfunction, transfusion of
Blood Plasma ,
Platelets and coagulation factors to stabilize blood
Coagulation , and drug and fluid therapy for circulatory failure. Ensuring adequate nutrition, if necessary by
Parenteral Nutrition , is important during prolonged illness.
Most therapies aimed at the inflammatory process itself have failed to improve outcome. However,
Drotrecogin Alfa (activated
Protein C , one of the
Coagulation Factor s) has been shown to decrease mortality from about 31% to about 25% in severe sepsis. Low dose
Cortisol treatment has shown promise for
Septic Shock patients with relative
Adrenal Insufficiency .
