Sepsis, a life-threatening condition caused by the body’s response to an infection, claims millions of lives each year. Detecting sepsis early is critical to survival, yet subtle symptoms often go unrecognized until it is too late. This article explores the key considerations around early sepsis detection.
What is sepsis?
Sepsis occurs when the body’s immune response to an infection spirals out of control, triggering widespread inflammation that can lead to tissue damage, organ failure, and death. Bacteria are the most common cause, but sepsis can also result from viral, fungal or parasitic infections. Sepsis progresses rapidly and can be fatal within hours if left untreated, with mortality rates as high as 50% for septic shock, the most severe form.
While sepsis can start anywhere, common infection sites include the lungs, urinary tract, skin and gut. Anyone can develop sepsis, but those with weakened immune systems are most vulnerable, including the very old, very young, chronically ill, and those with cancer or HIV/AIDS. Sepsis is a medical emergency requiring rapid diagnosis and immediate treatment, usually with IV antibiotics and fluids.
Why early detection matters
Sepsis has a continuum of severity. Identifying it quickly in its early stages offers the best chance for survival and prevents progression to severe sepsis, septic shock and eventual organ failure. Research shows:
- In the first hour that sepsis care is delayed, mortality rises by nearly 8%
- When treatment is delivered within 1 hour, survival is improved by nearly 80%
- Each hour of delay in antibiotics after sepsis onset increases mortality by roughly 8%
Early intervention helps curb the “cytokine storm” of inflammation driving sepsis and prevents complications. Prompt treatment also enables source control, such as draining an abscess or removing infected tissue. Later in the course of illness, these measures become less effective.
Challenges in early recognition
Catching sepsis early is difficult as initial symptoms are vague and easily mistaken for other conditions. Patients may simply complain of feeling unwell or appear to have a mild infection. However, there are some key reasons early sepsis goes undetected:
- Non-specific, flu-like symptoms: Early signs like fever, chills, fatigue, and muscle aches mirror many common illnesses.
- Insidious onset: Sepsis develops gradually, with subtle symptoms that worsen over hours to days.
- False sense of security: Mild initial symptoms and good vital signs can falsely reassure providers.
- Comorbid conditions: Chronic disease may obscure sepsis symptoms.
- Cognitive barriers: Sepsis is not top-of-mind for providers seeing vague complaints.
- Limited awareness: Public and provider understanding of sepsis warning signs is still lacking.
Together, these factors create “a perfect storm” where sepsis slides under the radar until it reaches a dangerous inflection point.
Who is at risk?
While any infection can trigger sepsis, some groups are at higher risk. Be especially vigilant for sepsis in patients who:
- Are very old or very young
- Have chronic conditions or weakened immunity
- Have indwelling devices like catheters or feeding tubes
- Are on medications suppressing immunity like steroids or chemotherapy
- Have had recent infections or hospitalizations
- Live in nursing homes or crowded conditions
- Have suffered trauma or burns
- Have recently undergone surgery or invasive procedures
- Are pregnant, postpartum, or have recently miscarried
Sepsis rates also tend to be higher in males, non-white ethnicities, and those of low socioeconomic status.
How is sepsis diagnosed?
Diagnosing sepsis requires astute clinical judgement, carefully piecing together subtle clues amidst ambiguous symptoms. No single lab test or vital sign confirms sepsis. Instead, providers synthesize data from:
- Patient history: Recent infections, medical conditions, medications, demographics that may predispose to infection
- Physical exam: Fever, elevated heart and respiratory rate, changes in mentation
- Labs: Presence of elevated white count, metabolic acidosis, organ dysfunction markers
- Cultures: Positive blood cultures confirming pathogens in the bloodstream
- Imaging: Evidence of infection sources like pneumonia on chest X-ray
- Clinical judgement: Overall impression of illness severity based on subtle patient changes
No single element confirms sepsis. Providers must recognize patterns and changes from baseline indicating possible sepsis.
Screening tools and criteria
Various screening tools and criteria aim to improve early sepsis detection by standardizing assessment:
SIRS criteria
SIRS (systemic inflammatory response syndrome) criteria screens for sepsis by identifying two or more of:
| Temperature >100.4°F or | Heart rate >90 bpm |
| Respiratory rate >20 breaths/min | White blood cell count >12,000 or 10% immature bands |
These were the first quantitative criteria proposed for sepsis, but have limited specificity. Many non-infectious conditions also cause SIRS.
qSOFA
Quick SOFA (qSOFA) assesses three quick bedside parameters:
| Respiratory rate ≥22/min | Altered mentation |
| Systolic blood pressure ≤100 mmHg |
Positive qSOFA (2+ criteria) indicates greater risk of poor outcomes. However, qSOFA lacks sensitivity in early sepsis.
Other screening tools
Other examples include:
- NEWS: National Early Warning Score
- MEWS: Modified Early Warning Score
- SEWS: Standardized Early Warning Score
These tools automate early warning systems. But no criteria is definitive for diagnosing sepsis itself.
Biomarkers in sepsis detection
Biomarkers are substances measurable in blood whose levels reflect presence and severity of infection. Some promising examples:
- Procalcitonin (PCT): Levels rise with bacterial infection and sepsis severity. May identify sepsis 3-6 hours earlier than other markers.
- C-reactive protein (CRP): Nonspecific inflammatory marker elevated in early sepsis.
- Lactate: Rising lactate indicates tissue hypoxia from sepsis-related shock.
While biomarkers show promise in early sepsis detection, levels initially may be normal. Serial testing is needed to confirm sepsis as disease progresses. More research is needed before biomarkers can be definitively recommended for screening.
Automated analytics
Given the multilayered data analysis needed to identify sepsis, machine learning and artificial intelligence hold great potential to automate detection by recognizing patterns too subtle for human recognition. Some ways these technologies could optimize early diagnosis:
- Analyzing trends in vital signs, labs, and clinical data to identify sepsis precursor patterns
- Integrating information from the EHR to relate new symptoms to medical history
- Providing checklist prompts to standardize sepsis screening
- Monitoring hospital data streams to flag high-risk patients
- Incorporating warning systems into everyday workflows
Intelligent software could assimilate sepsis risk factors and prompt earlier clinical evaluation, accelerating diagnosis. But these tools require abundant data to reach optimal performance.
Improving early detection
Given the urgency of rapid treatment, how can clinicians spot sepsis earlier?
- Maintain a high index of suspicion in at-risk patients
- Frequently reassess patients with infection for new onset organ dysfunction
- Learn subtle facial and body language cues of acutely ill patients
- Use screening tools and criteria to quantify abnormalities
- Recognize patterns in vital signs heralding deterioration
- Act promptly on nursing concerns of patient decline
- Incorporate sepsis protocols and checklists into routine care
- Leverage decision support tools and analytics strategies
- Improve public awareness of sepsis as a medical emergency
Earlier detection requires keen clinical acumen and constantly asking, “Could this be sepsis?” Quickly recognizing patterns and changes from baseline remain key.
In summary
Catching sepsis in its earliest phases is critical, yet extremely challenging due to non-specific symptoms. Clinical judgement, prompt workup, repeat assessment, screening tools, biomarkers and intelligent systems can aid prompt recognition. Increased awareness is vital – for the public, healthcare providers, and policy makers. With focused effort, the insidious nature of early sepsis can yield to earlier detection, saving countless lives.
