It is an overwhelming, haywire response by the body to an infection
By Eva Briggs, MD
One spring day in 1990, my father got out of bed and started for the bathroom. He only made it a few steps before collapsing in a heap on the floor. My mother called an ambulance. He wound up in the ICU with sepsis. That’s the same condition leading to former president Bill Clinton’s October hospitalization.
Sepsis is an overwhelming, haywire response by the body to an infection.
This reaction is called a systemic inflammatory response syndrome (SIRS). SIRS can also arise from noninfectious causes such as severe trauma, cancer, blocked circulation and others. Bacterial infections are the most common triggers of sepsis. Common sites are lung, urinary tract, skin or gastrointestinal tract. In Clinton’s case it was a urinary tract infection; in my father’s case a previously unsuspected gallbladder infection. Viral infections such as COVID-19 and influenza, fungal infections and protozoal infections are also capable of causing sepsis.
A combination of the infectious organism’s characteristics and the host’s factors produce sepsis. Infectious bacteria make substances to colonize the body, evade the immune system and establish disease. They manufacture chemicals that trigger the body’s inflammatory response. The body’s inflammatory system then spirals out of control, damaging immune cells, blood cells, blood vessels, as well as the tissues of the lung, brain, liver and kidneys.
An estimated 1.7 million adults in the United States develop sepsis each year and 270,000 of them die. The following groups are at highest risk:
– Adults older than 65 and children younger than 1.
– Immunosuppressed people.
– Those with chronic medical conditions such as diabetes, chronic lung disease, cancer and kidney disease.
– Anyone with a recent severe illness or hospitalization.
– People who have survived a previous episode of sepsis.
Sepsis is a true medical emergency. Signs and symptoms of sepsis can be cardiac, such as a racing rapid heart rate or low blood pressure. Neurologic signs are confusion and disorientation. Respiratory symptoms include shortness of breath. The patient can also have a fever, shivering, chills, or extreme pain. If you suspect that someone has sepsis, seek medical care immediately.
Sepsis can damage multiple organs in the body:
- Lungs — acute respiratory distress syndrome.
- Brain — encephalopathy leading to agitation and confusion. Blood clots can form in the small blood vessels of the brain. Multiple small micro abscesses can take root in the brain.
- Liver — an injured liver fails to produce blood clotting factors leading to widespread bleeding. The liver fails to remove metabolic waste products such as bilirubin and the patient becomes jaundiced.
- Kidney — damaged kidneys produce little or no urine output and permit toxins to accumulate.
- Cardiovascular — the heart muscle may fail, depriving the body of oxygen. Dilated blood vessels cause the blood pressure to drop.
When a physician suspects sepsis, they will attempt to determine the underlying cause and treat it with antibiotics, antivirals or antifungals. But most care is supportive. Oxygen, ventilator or other respiratory support. Medication to improve blood pressure and assist heart function. Dialysis for kidney failure. Transfusions of needed blood components.
As I write this, I don’t know what former president Clinton’s outcome is. In my father’s case, he somehow miraculously survived his episode of sepsis. He experienced lung failure, kidney failure and a bleeding ulcer. He walked out of the hospital weak, but mentally intact several weeks later and lived three more years. All thanks to the excellent care of the intensive care staff at Albany Medical Center.