Sepsis

What is sepsis?

The human body is constantly on alert, fighting off external agents that can cause harm, such as bacteria, viruses, fungi, and toxins

Every aggression to the body triggers a defense reaction, which, in most cases, is limited to fighting off these agents without causing additional harm. However, in some situations—either due to the severity and aggressiveness of the causative agent (especially certain types of bacteria and viruses), or the magnitude of the body’s response—this defense can result in secondary damage to the individual’s health. In other words, in response to an infection, the body may activate defense mechanisms that end up harming itself

Sepsis is a syndrome characterized by an imbalance between the oxygen available and the oxygen actually used by the cells

When this imbalance is not corrected, it can lead to single or multiple organ and system dysfunctions, associated with the body’s response to an infectious agent. This is what we call sepsis, and in more advanced cases, septic shock—commonly known as a generalized infection

In simpler terms, Sepsis is a condition in which the circulatory system may fail to provide adequate blood flow to meet the metabolic needs of tissues and vital organs (oxygen and nutrients). This is caused by an exaggerated systemic inflammatory response (vasodilation, increased vascular permeability, and accumulation of white blood cells), resulting in the inability to maintain blood pressure and a consequent reduction in blood perfusion to vital organs. These changes occur throughout the body and are observed even in areas where the infectious agent is not present

Clinical signs may include: Low blood pressure, signs of reduced blood flow to organs, drowsiness or mental confusion, decreased urine output, low platelet count, blood clotting abnormalities, respiratory disorders, cardiac dysfunction
A marker used to help diagnose this blood flow imbalance is the measurement of lactate in venous or arterial blood. Lactate is a byproduct of anaerobic metabolism, and when elevated, it indicates that the body is struggling to adequately perfuse its tissues and supply the minimum amount of oxygen needed for proper organ function

Septic Shock

This is a more advanced and severe stage of sepsis. It occurs when, despite the measures taken, the patient does not recover blood pressure or restore adequate blood flow to organs and systems

There are also other situations in which the body’s inflammatory response to an injury or external aggression becomes heightened and dysregulated, resulting in a serious condition with characteristics similar to sepsis, but without the presence of an infectious agent—such as in cases of pancreatitis, severe burns, major trauma, or extensive surgeries. This condition is known as Systemic Inflammatory Response Syndrome (SIRS)
Because it is a serious condition, sepsis requires rapid and precise treatment. Upon identifying early signs of sepsis, the infectious source must be investigated while treatment is initiated. In addition to routine tests, cultures of blood, urine, and any secretions should be collected

Immediate administration of antibiotics targeted to the suspected source is imperative. To correct blood flow and pressure disturbances, intravenous fluid infusion should be started

In cases of septic shock, where these measures are insufficient, vasoactive medications—such as norepinephrine—must be used to maintain adequate blood pressure and organ perfusion. These patients should be treated and monitored in intensive care units (ICUs)
The response to treatment depends on several factors: The body’s reaction to the infection, the location and type of infection, the aggressiveness of the infectious agent (hospital-acquired infections tend to be more severe), the type and effectiveness of the antibiotic, whether or not septic shock develops.
These factors cannot be assessed immediately; only time will reveal the outcome. Therefore, the response to sepsis treatment can only be evaluated after several hours or even days
Untreated sepsis or septic shock—or cases that do not respond well to treatment—can lead to multiple organ failure and death. Mortality rates range from 20% to 60%, depending on the severity of the case, especially in ICU patients, the elderly, immunocompromised individuals, or those with underlying health conditions (e.g., liver failure, cancer, diabetes, AIDS, transplant recipients)

However, when treatment is early and accurate, the chances of survival are good. We must remain vigilant

By Einstein Editorial Board