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What is Sepsis?
Sepsis is a life-threatening medical condition triggered by the body’s response to an infection. Normally, the immune system responds to infections by sending out chemicals to fight the disease locally. However, this response becomes dysregulated in Sepsis and can cause widespread inflammation.
Excessive inflammation and immense response in sepsis can lead to tissue damage, organ dysfunction, and impaired blood flow. Sepsis differs from localized infection because it involves a systemic reaction to the infection, impacting multiple organs and systems. Recognizing sepsis early is crucial for timely intervention and treatment to prevent severe complications and improve outcomes.
Symptoms of Sepsis:
Fever or Hypothermia
Sepsis can cause a high fever (temperature >101 F or 38.3 C)
Rapid Heart Rate (Tachycardia)
The heart rate may be significantly increased
Rapid Breathing (Tachypnea)
Breathing may be faster than normal.
Skin Changes
Patients may have mottled or discolored may indicate poor circulation and tissue perfusion.
Physical Discomfort
Sign of Sepsis, especially when accompanied by other symptoms of systemic infection
Sepsis Stages
Systemic Inflammatory Response Syndrome (SIRS)
SIRS is an inflammatory response throughout the body due to infection or other causes, characterized by abnormal body temperature, heart rate, respiratory rate, and white blood cell count.
Overview
What is SIRS?
SIRS (systemic inflammatory response syndrome) is an exaggerated defense response from your body to a harmful stressor. It causes severe inflammation throughout your body. This can lead to reversible or irreversible organ failure and even death.
Symptoms and Causes
Almost all people with sepsis have SIRS, but not all people with SIRS have sepsis.
What are the symptoms of SIRS?
Several conditions can cause SIRS, affecting many different areas of your body. Because of this, SIRS has a wide variety of symptoms. They may include:
Redness and swelling (edema) in the affected parts of your body.
Intense pain.
Loss of function of parts of your body.
Intense fatigue.
Fast heart rate (tachycardia).
Abnormal breathing.
Fever or hypothermia (low body temperature).
Shaking or chills.
Warm or clammy/sweaty skin.
Skin rash.
Confusion, agitation, or other mental changes.
Loss of consciousness.
What causes SIRS?
SIRS happens when your body’s immune system has an exaggerated response to a stressor. While your body normally uses inflammation to help you, this response is extreme, and the inflammation causes serious harm.
Several conditions and situations can trigger SIRS, some of which include:
Acute (sudden and severe) aspiration (when food, liquid, or other material enters your airway and lungs)
Acute end-organ ischemia (lack of blood flow to an organ)
Acute pancreatitis
An adverse reaction to a medication
Bacterial infection
Blood cancers (hematologic malignancy), like leukemia, lymphoma, and multiple myeloma
Burns
What are the risk factors for SIRS?
Risk factors for SIRS include:
Age: Infants and people over 65 are most at risk
Weakened immune system: People with weakened immune systems, such as from cancer treatment, HIV, or an organ transplant, are at increased risk
Chronic conditions: Certain chronic conditions can put you more at risk, like diabetes, cirrhosis, and COPD
Existing infection: Having a current infection like pneumonia, meningitis or cellulitis increases your risk of SIRS
Severe Sepsis:
Sepsis occurs when the body’s response to infection causes organ dysfunction, evidenced by changes in organ function (e.g. altered mental status, decreased urine output).
Any organ can be affected, your heart, brain, kidneys, lungs, and/or liver. The symptoms and experiences are based on which organ or organs are affected.
For example, if the lungs are damaged, your breathing is affected, if your kidneys are damaged, your ability to urinate is affected, and so on. People with severe sepsis can also develop a condition called acute respiratory distress syndrome (ARDS).
Severe sepsis symptoms can include:
Changes in skin color, or patches of discolored skin
Low or no urine output
Disorientation, drowsiness, changes in mental ability, loss of consciousness
Difficulty breathing
Abnormal heartbeat
Chills
Extreme weakness
Most people with severe sepsis must be treated in an intensive care unit (ICU), where they will receive fluids antibiotics, and treatment to try to reverse organ damage and prevent further damage. They are usually the sickest patients in the hospital and time is of the utmost importance.
Septic Shock:
Severe sepsis is sepsis with signs of organ dysfunction, while septic shock is a life-threatening condition where sepsis leads to profound circulatory, cellular, and metabolic abnormalities, resulting in significantly decreased blood pressure and inadequate tissue perfusion.
Symptoms and Causes
Septic shock is the third stage of sepsis. Early signs of sepsis can include:
Fast heart rate.
Fever or hypothermia (low body temperature).
Shaking or chills.
Warm, clammy, or sweaty skin.
Confusion or disorientation.
Hyperventilation (rapid breathing).
Shortness of breath.
When sepsis turns into septic shock, you may experience additional symptoms. These include:
Very low blood pressure.
Lightheadedness.
Little or no urine output.
Heart palpitations.
Cool and pale limbs.
Skin rash.
What causes septic shock?
Any infection can lead to sepsis which can then develop into septic shock if it worsens. Not every infection will lead to sepsis or septic shock. But, if an infection causes enough inflammation, it can develop into sepsis. Most of the common infections are from bacteria, but viruses can also cause infections and sepsis. Infections can start anywhere but commonly begin in your lungs, bladder, or stomach.
What are the risk factors for septic shock?
Your septic shock risk increases if you have a weakened immune system which increases your risk for sepsis. People with weakened immune systems include:
Newborns.
Those over age 65.
People who are pregnant.
People who use recreational drugs.
People with artificial joints or heart valves.
Impacted Organs:
Lungs (Pulmonary System)
Acute Respiratory Syndrome (ARDS): Severe sepsis can lead to ARDS, a condition characterized by fluid accumulation in the lungs, making it difficult to breathe and causing respiratory failure.
Kidneys (Renal System)
Sepsis can cause decreased blood flow to the kidneys leading to kidney dysfunction or failure. This can result in the accumulation of waste products and electrolyte imbalances in the body.
Liver (hepatic System)
Hepatic Dysfunction: Sepsis can impair liver function, leading to decreased synthesis of proteins, clotting factors, and other essential substances. This can result in coagulation abnormalities and metabolic disturbances.
Heart (Cardiovascular system):
Cardiac Dysfunction: Sepsis-induced inflammation can affect the heart, leading to myocardial depression and decreased cardiac output. This can result in low blood pressure and shock.
MOD-Multiple Organ Dysfunction Syndrome
MOD Score - Overview
The MOD score is a clinical tool used to examine the damage of organ dysfunction or organ failure in critically ill patients, especially for the evaluation of sepsis and septic shock patients. MOD score is often used in critical care units like ICU to monitor patients over time and predict outcomes.
The connection between MOD Score and Septic Shock:
The MOD score is directly related to the severity of septic shock because it measures organ dysfunction in a way that correlates with patient outcomes, including mortality. There are six parameters taken into account in the MODS score calculator for the Sepsis Patients.
They are:
Cardiovascular system – Measured by blood pressure and use of vasopressors.
Respiratory system – Measured by the PaO2/FiO2 ratio (a measure of oxygenation).
Renal system – Measured by serum creatinine levels and urine output.
Hepatic system – Measured by bilirubin levels.
Hematologic system – Measured by platelet count.
Neurologic system – Measured by Glasgow Coma Scale (GCS) score.
MOD Score Outcome Prediction in Septic Shock:
A higher MOD score reflects more severe organ dysfunction and is often a poor prognostic indicator in septic shock. As septic shock often leads to the dysfunction of multiple organs, the MOD score can help predict mortality and evaluate the progression of organ failure. Higher MOD scores are generally associated with higher mortality rates.
Studies have shown that MOD scores of 6 or more are strongly associated with high mortality in septic shock patients, with each additional point on the MOD score increasing the mortality rate. A rapid increase in the MOD score or failure to improve can indicate worsening septic shock or failure to respond to treatment.
Monitoring Organ Dysfunction:
The MOD score is useful for tracking the progression or reversal of organ failure during treatment of septic shock. For example, if a patient with septic shock shows a decrease in MOD score, it might indicate improvement in organ function due to appropriate treatment (e.g., antibiotics, vasopressors, mechanical ventilation).
In reverse, rising MOD scores can indicate deterioration and more aggressive interventions might be required (e.g., renal replacement therapy, changes in antimicrobial therapy, or surgical interventions to control the infection focus).
The following table introduces the scores in each component of the MODS score for multiple organ failure.
MODS | 0 | 1 | 2 | 3 | 4 |
PaO2/FiO2 ratio | >300 | 226 - 300 | 151 - 225 | 76 - 150 | 0 - 75 |
Platelet count as 103/mm3 | >120 | 81 - 120 | 51 - 80 | 21 - 50 | ≤20 |
Serum bilirubin in mg/dL (μmol/L) | ≤1.2 (20) | 1.3 - 3.5 (21 - 60) | 3.6 - 7.0 (61 - 120) | 7.0 - 14 (121 - 240) | >14 (240) |
Pressure-adjusted heart rate (HR*CVP/MAP) | 0 - 10 | 10.1 - 15 | 15.1 - 20 | 20.1 - 30 | >30.1 |
Glasgow Coma Scale | 15 | 13 - 14 | 10 - 12 | 7 - 9 | ≤6 |
Serum creatinine in mg/dL (μmol/L) | ≤1.1 (100) | 1.2 - 2.2 (101 - 200) | 2.3 - 3.9 (201 - 350) | 4.0 - 5.7 (351 - 500) | >5.7 (500) |
Multiple organ dysfunction score
Answers from all six of the parameters discussed above are summed up to provide the final MOD score which is then compared to the ICU Mortality percentile rate, Hospital Mortality percentile rate, and the ICU stays in number of days.
MODS | ICU mortality (%) | Hospital mortality (%) | ICU stay in days |
0 | 0 | 0 | 2 |
1 – 4 | 1 - 2% | 7% | 3 |
5 – 8 | 3 - 5% | 16% | 6 |
9 – 12 | 25% | 50% | 10 |
13 – 16 | 50% | 70% | 17 |
17 – 20 | 75% | 82% | 21 |
21 – 24 | 100% | 100% | n/a |
APACHE Score in association with Sepsis:
APACHE stands for Acute Physiology And Chronic Health Evaluation. It is a scoring system used to describe the morbidity of a patient when comparing the outcome with other Sepsis patients.
One of the vital ICU scoring systems. It is applied within 24 hours of admission of a patient to an intensive care unit (ICU). APACHE II was designed to measure the severity of disease for adult patients admitted to intensive care units.
A score from 0 to 71 is computed based on several measurements; higher scores correspond to more severe disease and a higher risk of death (mortality rate).
The score is calculated based on changes in several vital signs such as body temperature, blood pressure, heart rate, respiratory rate, and chronic health conditions.
Mortality Rates Based on APACHE Scores for Sepsis Patients:
Score 0 –10: Low risk, typically around 5-10% mortality.
Score 11 – 20: Moderate risk, 15-30% mortality.
Score 21 – 30: High risk, 30-50% mortality.
Score > 30: Very high risk, 50-90% mortality, depending on other clinical factors.
Connection between Sepsis and APACHE Scores:
Sepsis patients mostly have higher APACHE scores because sepsis is a severe, life-threatening infection that can lead to organ failure. Therefore, mortality rates for sepsis patients will often be at the higher end of these ranges.
For sepsis patients, an APACHE II score over 20 is associated with a significant increase in mortality risk, and those with scores over 30 are at especially high risk, with mortality rates approaching or exceeding 50%.
APACHE scores are useful in the intensive care unit (ICU) to predict outcomes and inform clinical decision-making, but they are only one part of the overall prognosis and management of the sepsis condition.
SOFA SCORE
The Sequential Organ Failure Assessment (SOFA) score is a scoring system that assesses the performance of several organ systems in the body neurologic, blood, liver, kidney, and blood pressure and assigns a score based on the data obtained in each category.
The score is based on six different scores,
Respiratory - The PaO2/FiO2 ratio is a measure of oxygenation efficiency in the lungs. It compares the amount of oxygen in the blood (PaO2) to the concentration of oxygen being delivered to the lungs (FiO2).
Cardiovascular - Its evaluation focuses on the patient’s hemodynamic status, particularly through the assessment of MAP mean arterial pressure.
Hepatic system - Assessing Bilirubin levels as a marker of liver function.
Coagulation system - Examining platelet counts.
Renal system - Evaluating creatinine and urine output.
Neurological system - Assessing the Glasgow Coma Scale (GCS) score.
A doctor in the ICU calculates this score every 24 hours for a patient right from admission until discharge. The patient with a SOFA score of 2 may have a high chance of survival, while a score greater than 11 indicates very low chance of survival.
Conclusion:
From our analysis, we can get a clear idea about What is Sepsis, the Symptoms of Sepsis, the Stages of Sepsis, the MOD Score, the APACHE Score, the SOFA Score, and the mortality rate for patients with sepsis, and how to use these tables and records to keep track of the patient's recovery process. We understand that Sepsis is a life-threatening disease. Continuous monitoring of the Patient's progress and timely treatment will reduce the mortality rate!!!
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