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Sepsis

Sepsis (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 is known as systemic inflammatory response syndrome. more...

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Septicemia 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.

Symptoms

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, 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.

Definition of sepsis

Sepsis can be diagnosed if there is a proven source of infection, such as 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).

Treatment

The therapy of sepsis rests on antibiotics, 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.

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Patients with chronic obstructive pulmonary disease are at higher risk of sepsis
From CHEST, 10/1/05 by David A. Hasselbacher

PURPOSE: Although studies have been completed examining the cause of death and rates of sepsis in patients with chronic obstructive pulmonary disease (COPD) no study has been completed examining COPD as a risk factor for sepsis. The goal of our study was to prospectively examine COPD as a risk factor for sepsis.

METHODS: Data from the Atherosclerosis Risk in Communities (ARIC) study (a prospective study of 15,792 U.S. adults age 45-65 years old) were used in this analysis, with up to 11 years of follow-up data available. A diagnosis of COPD was made using modified GOLD criteria (we added a "restrictive" category consisting of people with an FEV1/ FVC > 70% and an FVC < 80% predicted). Episodes of sepsis or pneumonia were obtained using diagnostic codes (ICD-9 codes 038 and 480-487, respectively) from hospital discharge. Out of 15,586 patients analyzed there were 136 documented cases of sepsis. A logistic regression, controlling for age, sex, cigarette smoking, body mass index, education level, family income was completed using the SUDAAN software package. A second regression model added hospitalization for pneumonia to the above noted variables.

RESULTS: The table depicts the classification of lung disease with incidence of sepsis, pneumonia, odds ratio for sepsis with 95% confidence intervals (controlling for the factors noted in the methods) and odds ratio for sepsis when controlled for pneumonia. Pneumonia was a very strong predictor of sepsis (odds ratio 22.7, 95% CI 14.5, 35.4).

CONCLUSION: Patients with GOLD stage 2 or higher COPD and those with restrictive disease had an increased risk for sepsis in this cohort. After controlling for pneumonia, the risk was attenuated, and only significant in patients with restrictive disease.

CLINICAL IMPLICATIONS: These findings suggest that most, but not all, of the increased risk of sepsis among patients with COPD is related to their increased risk of developing pneumonia.

DISCLOSURE: David Hasselbacher, None.

David A. Hasselbacher MD * David M. Mannino MD Rolando Berger MD University of Kentucky, Lexington, KY

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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