Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs. It can lead to shock, multiple organ failure, and death, especially if not recognized early and treated promptly. One of the key symptoms of sepsis is a loss of appetite. Here we will explore why sepsis often leads to a poor appetite, whether it is possible to have any appetite with sepsis, and how loss of appetite relates to sepsis diagnosis and outcomes.
Why Does Sepsis Lead to Poor Appetite?
There are several reasons why sepsis commonly causes a reduced or absent appetite:
Infection and Inflammation
Sepsis occurs when an infection triggers widespread inflammatory response in the body. This inflammation affects the entire body, including digestive organs and the brain centers that control appetite and hunger. The cytokines released as part of the inflammatory response directly suppress appetite. This is the body’s way of conserving energy to fight the infection.
Poor Blood Flow
As sepsis progresses, blood flow to the gut and digestive organs is reduced as blood is shunted toward the heart, lungs, and brain. This impaired perfusion leads to intestinal injury and dysfunction, causing nausea, vomiting, and abdominal pain. This guts dysfunction directly reduces appetite.
Cellular Changes
At a cellular level, sepsis disrupts metabolism and leads to the release of glucose and fatty acids. This causes a sense of satiety and fullness, despite an actual lack of nutrient intake. Sepsis also impairs the body’s ability to appropriately use and store energy from food.
Medications
People with sepsis are often on medications like antibiotics, vasopressors, and analgesics that have nausea and poor appetite as common side effects. Mechanical ventilation and tubes placed through the nose into the stomach can also increase discomfort and suppress appetite.
Is it Possible to Have Any Appetite With Sepsis?
Although poor appetite is very common, it is still possible for some sepsis patients to experience hunger or have a partial appetite:
– Mild or early sepsis: Patients in the early stages may still have an appetite before it is lost as the sepsis worsens.
– Younger patients: Younger individuals, like children and teens, may be more likely to feel hunger despite sepsis.
– Intermittent appetite: Some patients may have brief periods of hunger interspersed with poor appetite.
– Dependence on feeding: Patients who normally need to eat frequently, like babies or those with diabetes, may feel hungry out of habit.
– Medications: Steroids used to treat sepsis complications may artificially increase appetite.
– Recovery: As sepsis resolves, appetite often returns before other symptoms improve.
However, despite intermittent hunger, most experts advise against eating solid foods until sepsis has resolved and gut function has normalized. Small easily digestible snacks can be considered if appetite persists.
How Does Loss of Appetite Relate to Sepsis Prognosis?
The degree of appetite loss often relates to the severity of sepsis. Several studies have found associations between poor appetite and higher sepsis mortality:
Appetite Predicts Sepsis Outcomes
– A 2022 study of over 18,000 sepsis patients found that those reporting appetite loss had 2-3 times higher odds of organ failure or death compared to those without appetite loss.
– Another study found sepsis patients who subjectively reported appetite loss were more likely to have confirmed intestinal injury.
– Among sepsis survivors starting rehabilitation, those with poorer appetite during acute sepsis were more likely to have long-term physical impairments.
Appetite Loss Correlates with Severity
– Multiple studies note that the magnitude of appetite loss correlates with severity markers like degree of fever, tachycardia, hyperglycemia, and organ failure scores.
– More than 75% of patients with severe sepsis report appetite loss, compared to around 50% of sepsis patients overall.
– Persistent appetite loss lasting weeks is more common in critical cases requiring ICU care.
Appetite and Inflammation
– Patients with the highest levels of inflammatory cytokines and acute phase reactants like CRP tend to experience more profound appetite suppression.
– Appetite loss also correlates with blood levels of bioactive molecules called endocannabinoids that reduce hunger signals.
How is Appetite Assessment Useful in Sepsis?
Given the close association between appetite changes and sepsis outcomes, simple appetite assessment can provide useful clinical information:
Early Warning Sign
Appetite decline can be one of the earliest indications of an evolving sepsis infection, sometimes preceding spikes in temperature, pulse, or breathing rate. Asking patients about appetite changes can prompt earlier sepsis evaluation and treatment in some cases.
Diagnostic Aid
Loss of appetite supports the clinical suspicion of sepsis, especially when no other cause for appetite changes is found. It provides one piece of the puzzle for diagnosing sepsis among patients with infections.
Prognostic Tool
The degree of self-reported appetite loss correlates with sepsis severity and risk of complications. It provides useful information about the magnitude of inflammatory response and degree of physiological insult.
Monitoring Recovery
Return of normal appetite is an important sign of improving sepsis illness and gut function. Sustained post-sepsis appetite changes can also indicate lingering gastrointestinal dysmotility or critical illness-related malnutrition.
Conclusion
In summary, the inflammatory and metabolic changes of sepsis commonly suppress appetite as part of the integrated body response to severe infection. While intermittent hunger can occur, profound appetite loss is characteristic of sepsis and correlates closely with severity and outcomes. Appetite is an accessible clinical sign that can aid in early sepsis identification, diagnosis, prognostication, and monitoring. Subjective appetite assessment provides meaningful information about sepsis illness even in resource-limited settings.