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| '''Sepsis''' is a serious medical condition caused by a severe systemic ] leading to a ]. The more critical subsets of sepsis include severe sepsis (sepsis with organ dysfunction) and ] (sepsis with refractory arterial ]). | '''Sepsis''' (in ] '''''Σήψις''''') is a serious medical condition caused by a severe systemic ] leading to a ]. The more critical subsets of sepsis include severe sepsis (sepsis with organ dysfunction) and ] (sepsis with refractory arterial ]). | ||
| The systemic inflammatory response syndrome leads to widespread activation of ] and ] pathways. This may progress to dysfunction of the ] and, even under optimal treatment, ] and eventually death. | The systemic inflammatory response syndrome leads to widespread activation of ] and ] pathways. This may progress to dysfunction of the ] and, even under optimal treatment, ] and eventually death. | ||
Revision as of 23:13, 7 January 2005
Sepsis (in Greek Σήψις) is a serious medical condition caused by a severe systemic infection leading to a systemic inflammatory response. The more critical subsets of sepsis include severe sepsis (sepsis with organ dysfunction) and septic shock (sepsis with refractory arterial hypotension).
The systemic inflammatory response syndrome 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 more 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 (Martin et al 2003).
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.
Most therapies aimed at the inflammatory process itself have failed to improve outcome. However, drotrecogin (activated protein C, one of the coagulation factors) has been shown to decrease mortality from about 31% to about 25% in severe sepsis (Bernard et al 2001). Low dose cortisol treatment has shown promise for septic shock patients with relative adrenal insufficiency.
Related conditions
- infection is an inflammatory response to a microorganism, or the invasion of normally sterile host tissues by the organism.
- bacteraemia is the presence of bacteria in the blood. Bacteraemia can occur in sepsis and other serious diseases such as infective endocarditis, but it may also be a harmless and transient condition.
- diffuse intravascular coagulation (DIC)
- multiple organ dysfunction syndrome
References
- Bernard GR, Vincent JL, Laterre PF, LaRosa SP, Dhainaut JF, Lopez-Rodriguez A, Steingrub JS, Garber GE, Helterbrand JD, Ely EW, Fisher CJ Jr; Recombinant human protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study group. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001;344:699-709. PMID 11236773
- Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003;348:1546-54. PMID 12700374