Over sepsis – Sepsibel

Sepsis is a common disease. The World Health Organisation (WHO) estimates the number of annual cases at 50 million worldwide. Yet sepsis is often still unknown to the general public. Consequently, people affected by it, either as patients or as family members, are often left with many questions. We collected the most frequently asked questions about sepsis and put them to a specialist, Dr Ken Dewitte, emergency physician and coordinator of the sepsis team at Antwerp University Hospital.

What is sepsis?

Sepsis is an extreme reaction of the body to a common infection.

20% of sepsis victims die
40% of sepsis survivors experience severe and persistent symptoms

Every hour counts

Early detection and prompt treatment saves lives

The introduction of alert criteria in hospitals and GPs to quickly identify critical patients is vital.

The symptoms of SEPSIS:

Slurred speech, drowsiness, drowsy, fainting, confused
Extreme chills, fever or pain (so much that you think you will die)
Pipi stay out all day
Speedy heartbeat, low blood pressure
Ihave breathing difficulties
Stips/spots: reddish-purple, blue or purple

Sepsis can affect anyone

40.952 Belgians per year develop Sepsis*
7.675 sepsis victims die*

Anyone can get sepsis, but some are at increased risk:

Adults > 60 years
Children < 1 year
People with weakened immune systems (due to chemo, diabetes, AIDS)
People without spleens
Chronic lung, heart or liver patients
People who underwent an invasive procedure (surgery, biopsy, puncture) in the last 6 weeks
Patients with a catheter
People with cuts, burns, blisters or skin infections

*These figures are based on a reputable scientific study, exact counts are not available as sepsis is still not registered in Belgium.

Long-term effects of sepsis

Physical

Amputations
Organ damage
Sleep problems
Fatigue, lethargy
Respiratory problems
Muscle and joint pains
Swollen limbs
Recurrent infections
Reduced appetite
Organ dysfunction for kidneys, liver, heart, lungs,...
Hair loss
Skin rash

Psychological and emotional

Hallucinations
Panic attacks
Flashbacks
Nightmares
Cognitive problems such as with concentration, memory, multitasking,...
Brain fog
Over-stimulation
Lose self-confidence
Depression
Post traumatic stress syndrome (PTSD)

National sepsis plan

On 31/05/2024, a proposal of a national sepsis plan was handed over to the Minister of Health. Proud that we as Sepsibel were able to participate in the panel of sepsis experts led by Prof Erika Vlieghe. We therefore hope that a national sepsis plan will soon be implemented in Belgium as recommended by the WHO in 2017.

Awareness around sepsis

Among the general public and medical staff

Why awareness around sepsis is so important:

To save lives through early recognition
To be heard around the serious consequences in a life after sepsis

What is sepsis?

"Sepsis is an extraordinary reaction of the body to an infection. It is an "ordinary" infection, such as the flu, a strep throat or an infected wound, where the bacteria or virus enters the bloodstream and triggers a massive immune response resulting in organ damage. These include the kidneys failing or the heart or lungs no longer functioning properly."

Is sepsis the same as blood poisoning?

"Colloquially, sepsis is indeed called blood poisoning. After all, sepsis is caused by a virus or bacteria entering the bloodstream. But while there are other forms of blood poisoning, the distinctive feature of sepsis is that it is an extreme immune reaction that starts damaging the organs."

Some COVID patients also experience an immune system overreaction. Do they then also have sepsis?

"The clinical picture we see in some COVID patients is indeed similar to sepsis. There is an extraordinary immune response in both cases. Because of the lung destruction that can occur in COVID-19, the virus can enter the bloodstream with consequences similar to sepsis. Scientists agree that COVID-19 can cause sepsis but fortunately this only happens in a minority of cases, notably 2 to 5%. "

Is there such a thing as a mild case of sepsis?

"There used to be a distinction in science between "sepsis" and "severe sepsis". Today, we no longer make that distinction because the definition of sepsis states that there is organ damage and that is always severe."
"You can have a mild infection, where the body responds normally and appropriately to attack the virus or bacteria. Then we are talking about a cold, a viral pneumonia, or a COVID-19 infection with mild symptoms. But when that infection becomes a sepsis, "mild" no longer applies. For that, the reaction is too excessive and the impact on the organs too great."

What are the symptoms of sepsis?

"People with sepsis usually feel very bad. They have a fever,become short of breath and dizzy, their pulse increases and they are confused. In more advanced cases, people also start getting blushed skin and having to urinate less."

What should you do if you have sepsis?

"In any case, you have to go to the hospital immediately. We see patients who are referred by their GP, but also people who come straight to the emergency room because they are so sick. Responding quickly is incredibly important because from the moment you go into sepsis, you deteriorate rapidly within a few hours."

Why is quick action so important when (suspecting) sepsis?

"Sepsis is an urgency. When a patient comes in to hospital, they have to be treated within the hour to prevent worse. Sepsis happens very quickly now. From when the reaction sets in until the organ damage starts, we are only talking about hours. The sooner one starts therapy, the better off patients are. Responding quickly can reduce the risk of death by tens of per cent."

Can you recover from sepsis without medical intervention?

"In principle, no. Sepsis is a very serious syndrome that will not just "pass". Without intervention, the chances of survival are very low."

How is sepsis diagnosed?

We use an internationally established definition for diagnosis that relies on a number of clinical signs that the patient exhibits. These are added up to a score that indicates whether there is severe organ damage."
"After all, there is no conclusive diagnostic test for sepsis. In only 30% of cases can we identify the bacteria, also because it is often a viral infection."

What is the treatment for sepsis?

"First of all, we give antibiotics to fight a bacterial infection. Usually, there is a need for fluid administration because the blood vessels are opening up and because the patient has lost fluids due to fever or has not drunk much. In some cases, we also need to give oxygen because the lungs are affected or there is poor circulation. Often we also have to administer medication to make the blood vessels contract to squeeze."

Is sepsis also treated with steroids?

"Sometimes cortisone is indeed needed to support the adrenal gland. But it is certainly not a standard treatment. It can be confusing for the family, when they hear that their relative is not given steroids and someone else they know is. But sepsis can present very differently. Moreover, steroids also have many side effects. As with a lot of treatments, it's a weighing up of pros and cons."

Is there any evolution in the treatment of sepsis?

"The treatment of sepsis is constantly evolving and I assume that in the future there will be very advanced techniques on the market, working on the basis of our DNA, for example. This type of medicine is called "precision medicine" where drugs are developed that are adapted to genetic variations and take lifestyle and environmental factors into account. Another fascinating area of science is treatments adapted to the so-called microbiome, being the bacteria in our gut. Within this area of science, there is also a lot of focus on prevention of sepsis in critically ill patients."

Should a sepsis patient always go to intensive care?

"In principle, the place for a sepsis patient is in intensive care. Only if there is therapy limitation do patients, in consultation with the family, not go to intensive care. But then we are talking about people who have already gone through a long ordeal and in whom the prognosis is very poor."

What can sepsis patients and families expect?

"A sepsis progresses very quickly in the beginning and then requires long-term treatment. In a sepsis that is quickly recognised and treated, a patient may stay in intensive care for only two to three days and then be stable enough to go to the ward. Then we speak of a sepsis that can be quickly reversed by rapid, adequate therapy."
"But in some cases, we cannot prevent a very severe reaction, despite all therapy. These patients typically need circulatory, cardiac and renal support. Most is done with medication, but often they have problems with the lungs and need artificial ventilation, for which they are put into an artificial coma. With severe problems with the kidneys, we have to start dialysis if necessary, and if the lungs or heart have become very badly affected, we sometimes even have to use a heart-lung machine, but this is fortunately rare. Those most severe cases really involve suffering in intensive care with a high risk of death. You should know that despite all these advanced techniques, 20 to 30% of sepsis patients still die in hospital. Family members of such severely ill patients should be prepared for a lengthy process with potentially invasive techniques and a high risk of complications during the stay in intensive care such as bedsores and even loss of limbs. Fortunately, in most patients it does not come to that: 70-80% comes out relatively well. But it must be remembered that sepsis is a very serious illness. Treatment in hospital can take weeks to months."

Does sepsis have lasting physical consequences?

"Patients who have received prompt diagnosis and treatment and have experienced no complications may leave hospital without permanent consequences. However, the most severe sepsis patients may suffer permanent organ damage. Some patients have definitive damage to the heart or lungs resulting in reduced exercise tolerance. There may be damage to nerve pathways with reduced muscle strength and difficulty walking. A few have to undergo one or more amputations. This is because medication has to be started that causes the vessels to contract to squeeze shut, reducing oxygen and blood supply to limbs. But the disease itself can also affect the vessels in the limbs.

Can sepsis also have long-term cognitive effects?

"Yes. Some patients can't concentrate as well if there has been oxygen deprivation in the brain. And we also see patients struggling with anxiety disorders and depression. Patients need to be prepared that, when they leave hospital, they cannot just pick up their old life and job as usual. It is therefore very important that they feel no hesitation in seeking information or help from their GP or specialist."

Should patients rehabilitate after sepsis?

"Every patient is different and the consequences of sepsis vary a lot. For some of these consequences, for example generalised weakness, it is also not so obvious to start a rehabilitation programme. Specific rehabilitation pathways such as cardiac or prosthetic rehabilitation do exist. Yet, one hears many stories of patients who are discharged from hospital and really struggle with the consequences of sepsis. Moreover, what we often see is that patients are left with a lot of questions and do not dare to put them to their doctor or specialist. It is very important that people know they have a right to information and help."

Are there certain people who are more predisposed to get sepsis in response to inflammation?

"Why some people develop sepsis and others do not is an important topic of research. But obviously people with impaired immune systems, for example people with HIV or people taking immune-suppressing medication, have an increased risk. We also see this in older people and very young children. An important risk group are people who have not been vaccinated against influenza or whooping cough, for example. So correct vaccination is also very important in terms of sepsis prevention."

Are there ways to prevent sepsis?

"As such, you can't really avoid sepsis, for example by boosting your immunity. But what you can avoid is the infection that can lead to sepsis. And here we are talking about the standard hygienic measures: washing hands regularly, disinfecting and caring for wounds properly, going to the GP in time if you feel ill, not hanging around seriously ill patients,... Moreover, vaccinations remain very important: polio, meningitis or whooping cough, for example, these are bacteria and viruses to which we know we can react very badly and that they have a very high mortality rate. So by making sure you don't get those infections, you can avoid the consequences of the disease itself or the sepsis that can occur from it."

How common is sepsis in Belgium?

"We don't know that exactly, but some figures are known. For example, hospitals document nosocomial sepsis, which is sepsis that arises in hospital, for example from catheters or after surgery. Those figures are reported to Sciensano,a federal research institution that collects these kinds of figures around public health. Other sepsis figures are not tracked and that is a problem. Because the vast majority of sepsis cases (up to 85%) arise outside the hospital. And so we don't actually know the state of sepsis in Belgium. How well are we doing? How big is the problem? Or is it not that bad? If you don't know what the numbers are, then you're not going to be able to change anything about it."

Is sepsis known enough?

"There is definitely a lack of knowledge among the general population about sepsis. And because sepsis usually starts outside the hospital, that's where a big challenge lies. In the hospital, you can set up endless quality projects around sepsis. And you need to, because postoperative and catheter sepsis exists. But those projects are never going to have as much effect as increased awareness among the general population. If we can increase knowledge of the symptoms and danger of sepsis, we can intervene before sepsis is too advanced. That's about knowing, for example, when a family member is no longer just sickly. Intervening in time is incredibly important. That is where things often go wrong. Patients often wait too long because they think they have an ordinary infection."

Imagine this: your father is not a high-risk patient, has a throat infection and is running a high fever. So when should you worry? Because he always makes high fever when he is sick. So how do you know that that line to sepsis has been crossed?

"That is a very good, but also a very difficult question. That is why it is so important to consult a doctor when in doubt. A doctor can ask targeted questions to assess whether there is a risk of sepsis. In England, an interesting campaign is running where they introduced the slogan "just ask: could it be sepsis?". They advise seeking medical help if there is slurred speech, chills, little urination, severe shortness of breath, discoloured or mottled skin. Also, if the patient says he feels abnormally ill, an alarm bell should sound."

What should GPs and home nurses do when sepsis is suspected?

"Sepsis is not an illness that can be managed at home. The best reflex is to get patients with suspected sepsis into the emergency department as soon as possible. Only in hospital can diagnosis and treatment take place. But by recognising sepsis in time and getting patients transferred to hospital, they have already helped their patients a lot."