'It can kill in hours,' says expert. The silent killer we still don't take serious enough
The perception of sepsis is that it’s a rare disease that unfortunate people get from stepping on a rusty nail or a stint in a filthy hospital.
But experts say this couldn’t be further from the truth. Sepsis is a deadly illness that can affect anyone of any age and can kill in a matter of hours.
In the UK, around 50,000 people die from sepsis every year, which is equivalent to over five deaths every hour, according to Sepsis Research FEAT (Fiona Elizabeth Agnew Trust) charity.
To fully understand this life-threatening condition, we’ve asked Dr Conway Morris and fellow expert Dr Ron Daniels BEM, Founder and Chief Medical Officer of the UK Sepsis Trust to explain all.
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Who is most at risk?
Sepsis is as common as heart attacks in the UK with nearly 80,000 people suffering life-changing after-effects each year in the UK, according to UK Sepsis Trust.
Anyone is potentially at risk from sepsis, but higher-risk groups include immunocompromised people (post-chemotherapy or organ transplant recipients for example), those with chronic conditions such as diabetes, heart disease, or kidney disease and the very young and elderly.
Dr Daniels says: ‘It is important to reinforce that sepsis can affect everyone. But the most likely to develop sepsis are people at the extremes of age, so older adults and very young children. People who have impaired immunity are at risk, plus individuals with HIV and AIDS and those having cancer treatment. Another group at risk are people who have long term conditions such as diabetes and COPD and unfortunately, women who are pregnant are slightly more at risk of sepsis than adults of similar age who are not pregnant.
‘That said, because of the physiological changes in pregnancy, they're less likely to die. Anyone who has had recent surgery or trauma, anything that breaches the skin and upsets their immune system, is also at risk. Sepsis presents itself very differently in each patient and can be challenging to identify.’
What are the early warning signs of sepsis?
Our experts agree early recognition and rapid action can save lives. Here are five key symptoms to look out for, according to Sepsis Research FEAT.
- A very high or low temperature
- Uncontrolled shivering
- Confusion
- Passing little urine
- Blotchy or cold arms and legs
Dr Daniels says: ‘Obviously, we don't want people with very early signs that could be anything heading straight to A&E. At the outset, sepsis can feel like a very bad cold or the flu and you’ll feel lethargic. People tend to look reasonably well and early features are the same as any other infection. But it's likely to feel slightly worse than any other infections you've experienced before. Instead of a common cold it might feel more like the flu.
‘You might have myalgia (aching muscles) and a high temperature. It is important to also note that a very low temperature, below 36 degrees, is also a significant sign of sepsis. Become aware of the warning signs and if you're worried or deteriorating call 111 or your GP and ask, could it be sepsis?’
Dr Conway Morris reveals more symptoms to look out for in the early stages of sepsis. ‘Look for rapid breathing, very cold hands and feet, mottled skin or a non-blanching rash (“the glass test” often used to detect meningitis), confusion or sleepiness and not having passed urine for 6-12 hours. But the cardinal symptom is feeling more unwell than you ever have before.
‘The early symptoms can be hard to distinguish and so watch for their progression or failure to improve.’
How fast will sepsis progress?
Dr Conway Morris says sepsis can arise from any infection and interacts with each person differently so progression can be very fast (hours) or slower (days). ‘It always starts with an infection, so if someone has symptoms of an infection (which will vary depending on the site of infection) they should look out for additional symptoms and rapid worsening or failure to get better after taking oral fluids and paracetamol and if necessary, seek medical attention.’
Dr Daniels advises to monitor progress closely and trust your instincts. ‘If you've never felt this ill before and particularly if you're getting worse instead of getting better, that's the time that you need to access professional healthcare. Ask yourself – does this feel abnormal? Am I getting worse, not better? Does it feel like something terrible is happening to me?’
What rapid action can we take when faced with sepsis?
Dr Conway Morris says: ‘Anyone who suspects that they or a loved one is developing sepsis should seek urgent medical attention. Depending on how unwell a person is, this might mean travelling to an emergency department or if they’re very unwell calling 999. As sepsis can present in a variety of ways it is difficult to be prescriptive about how and when to seek medical attention so trust your instincts. Don’t put things off for a day in the hope it will get better.’
Dr Daniels says: ‘The current advice is to only take paracetamol if you are very symptomatic with a high temperature or if you're getting what we call rigors, which is a fancy term for excessive shivering. Make sure you let someone close to you, or the person suffering, know what's happening and try to stay hydrated until help arrives.’
Why is it important to speak up?
Dr Daniels says it’s vital to tell a healthcare professional why you think it is an infection and why it feels worse than normal.
He says: ‘This is about advocacy and being prepared to push and be assertive – that’s the need. People need to advocate for each other and for themselves and if you are dismissed by a healthcare professional ask the direct question: could it be sepsis?
Making a connection to the possible source of infection will also help says Dr Daniels. ‘The general symptoms affect your whole body, but the specific ones to infections will vary according to where the infection lands – whether it's a UTI or pneumonia. You might have a cough with coloured phlegm or severe abdominal pain or swelling or perhaps you have had a recent infected cut, bite or sting on the skin. Share this information and trust your instincts.’
Dr Conway Morris says it’s important to remember sepsis can develop over time. ‘If a doctor or other healthcare professional says your infection is not developing into sepsis ask them before you leave: “what should I look out for?” or “what should prompt me to come back”? This ‘safety netting’ is standard practice in acute and emergency care and it is a reasonable question to ask if the healthcare professional has not already told you. Better to ask than miss sepsis later.’
What are the biggest myths around sepsis?
One of the biggest misconceptions is that sepsis is something that only affects old people, according to Dr Daniels.
‘Elderly people are more likely to develop sepsis than younger people, but because our population is not linear and there's a huge number of 40-year-olds compared to 80-year-olds we see almost as many working-age adults with sepsis as we do retirement-age adults in our hospitals.
He says another misconception is that sepsis is linked to dirty cuts. ‘This harks back to the older term blood poisoning and perhaps also to septicaemia. Infected skin from cuts only accounts for about 10% of cases. By far the majority is from pneumonia and UTIs. It’s also often thought that sepsis is the fault of dirty hospitals and that's not true either. More than 80% of cases of sepsis arise in the community.’
Dr Conway Morris says the biggest myth is that sepsis only happens to other people. ‘And that it’s something that’s only seen in people who are already unwell from other causes. It really can affect anyone. That’s why everyone needs to know the symptoms and what to look out for.’
What are the long-term impacts to survivors of sepsis?
A whopping 82% of sepsis survivors experience ‘Post-Sepsis Syndrome’ more than a year after hospital discharge, according to UK Sepsis Trust.
Dr Daniels explains: ‘Some people recover from sepsis quickly and return to normal within a matter of weeks, but they are the minority. We tend to say to most people that it will take 12 to 18 months to return to 95% of their previous self.
‘The long-term impacts affect roughly half of people at one year after sepsis. These include cognitive problems such as brain fog; psychological problems, which can range from relatively minor and annoying (but not life changing) such as disturbed sleep through to PTSD. This occurs in about a fifth of people whose sepsis is bad enough that they need intensive care.
‘And there are physical problems. Some are very visible, such as the loss of limbs or digits in extreme cases (less than 2% of survivors) but the invisible disabilities can range from brittle hair and nails or loose teeth to severe pain syndromes and chronic fatigue. Half of people have a disability in one of these three domains one year after contracting sepsis.’
Dr Conway Morris says: ‘In extreme cases people suffer life-changing injuries such as loss of limbs due to impaired blood flow during sepsis, but even those without visible changes often suffer prolonged physical, psychological and social harms. Symptoms of what is often called “Post-Sepsis Syndrome” include fatigue, muscle weakness, breathlessness, clouded cognition and reduced attention span, vivid dreams, anxiety and post-traumatic stress reactions. We don't fully understand what drives these long-term effects, but it is an area of active research.’
How can sepsis be prevented in our day-to-day lives?
Dr Daniels says clean, healthy living is key to preventing sepsis.
‘Having a healthy diet, getting some exercise, not smoking and having moderate alcohol will reduce the risk. There are also simple things people don’t normally consider such as feminine hygiene, keeping cuts clean and dry, washing your hands regularly and covering your mouth when you cough or sneeze to prevent spreading germs, which all help to reduce the risks of sepsis.
‘Also look at what vaccinations are available to your age group. For older people that’s the flu vaccine, which will include the pneumococcal vaccine. Younger people who haven’t had the meningitis vaccine in school can still access it through their GP until their 25th birthday.’
Dr Conway Morris agrees. ‘The best immune system boost against infection is vaccination. I would encourage those who are eligible to protect themselves by getting vaccinated. People who are especially vulnerable to infections may want to consider wearing a FFP3/N95 mask in public areas but take advice from a healthcare professional as to whether this is necessary.’
What are the main takeaways?
Dr Daniels: ‘What’s important is being prepared to advocate for you or a loved one who is deteriorating with an infection. What often makes the difference between a good outcome and a bad outcome of sepsis is simply asking the right questions and pushing. It might even involve making a slight nuisance of yourself.
Dr Conway Morris adds: ‘People need to be aware of sepsis as a severe and life-threatening syndrome and know how to recognise it early on and seek appropriate help. This complex situation where the body’s own defences turn against it, remains poorly understood and we need urgent research into how it starts, how it can be detected, what can be done to treat it and how we can best support those who survive into recovery.’
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