Sepsis: A Physician’s Perspective

RAHUL KASHYAP, MD, MBA, is a clinical research scientist and assistant professor at the Mayo Clinic in Rochester, Minn. 

BSTQ: What is sepsis?

Dr. Kashyap: When a person gets an infection, the body releases chemicals into the bloodstream to fight off the infection. In some cases, those chemicals can trigger inflammation throughout the body. That inflammatory response is sepsis. If it’s not treated promptly, sepsis can progress, lowering blood pressure and making it hard for blood to reach vital organs. As a result, the heart, lungs, brain and kidneys all can be damaged. If it continues, sepsis can develop into septic shock, a life-threatening situation in which organs begin to fail and blood pressure drops even more dramatically. Any kind of infection can trigger sepsis. But certain infections such as pneumonia, abdominal or kidney infection and infections that affect the blood are more likely to cause sepsis.

BSTQ: Who is most at risk for developing sepsis?

Dr. Kashyap: Age is a significant risk factor. The elderly and the very young are at higher risk because the immune system tends to be weaker in elderly adults, and it’s not fully developed in infants. Other people with weak immune systems are more vulnerable to sepsis, too. Many people have weakened immune systems due to medical conditions, putting them at higher risk. A severe illness that requires hospitalization also can lead to problems with a person’s immune system, raising the sepsis risk.

BSTQ: How is sepsis diagnosed?

Dr. Kashyap: Sepsis develops quickly, and it can be difficult to identify in its early stages. Symptoms include high fever, fast heart rate and rapid breathing. As sepsis worsens, it can trigger an abrupt change in mental status such as disorientation or confusion. A significant decrease in urine production usually is a sign that sepsis is affecting the kidneys and other vital organs. If someone who has an infection begins to experience sepsis symptoms, it is critical he or she gets medical care right away. Hospital staff members watch patients closely for sepsis, particularly those in the emergency department and in ICUs. Patients diagnosed with sepsis receive plenty of IV fluids and are immediately given antibiotics.

BSTQ: How is sepsis treated?

Dr. Kashyap: People who have sepsis may require hospitalization. In addition to antibiotics and hydration, other medications may be used to treat symptoms such as low blood pressure. People whose conditions progress to septic shock often require care in an ICU, where they receive oxygen and bolus IV fluids. They also may need a machine to help them breathe. The longer sepsis is allowed to progress, the higher the chances it will become life-threatening. Research has shown, however, that if treatment is started within the first few hours from the time sepsis begins, the death rate from sepsis falls significantly. That makes early, aggressive treatment of sepsis crucial. If it is caught quickly, sepsis often can be managed effectively.

 BSTQ: What drives your interest in effectively treating sepsis? 

Dr. Kashyap: Sepsis has been listed as one of the top 10 causes of death — not only globally by the World Health Organization, but also by U.S. hospitals. There’s an unwritten rule in the ICU: Unless it’s otherwise ruled out, you assume sepsis in every single patient you treat. I have personal reasons as well. I lost my grandfather five years ago because of sepsis. While I had done some work before that experience, I’m a bit more passionate about it now in terms of seeing how we can find a cure. One of the questions I have is: How can we use technology and make sure there’s enough knowledge around sepsis signs and symptoms?

BSTQ: How do you think technology can be harnessed to treat sepsis?

Dr. Kashyap: Smart technology use can help not only with sepsis predication and detection, but also with sepsis treatment and outcome improvement. Machine learning algorithms can use vast information from electronic medical charts, deploy an early alert system for new sepsis diagnosis, and indicate failure to meet sepsis treatment guidelines. Smart technology monitoring in the critical care setting has potential for improved compliance with treatment, thus improving mortality rates. When pairing sepsis recognition technology with a sepsis response team, the death rates could be brought down substantially.