Stages of Sepsis
Sepsis refers to a potentially life-threatening syndrome that triggers the body's response to an infection, typically in the lungs, skin, or urinary or gastrointestinal tracts. The immune system functions by protecting the body from infections and illness. However, a person's body can go into an over-extended chain reaction to an infection, with immune chemicals entering the bloodstream to fight the infection. This extreme response to a disease is closely similar to a systemic inflammatory immune response, but the two should not be confused.
In sepsis, immune chemicals in the bloodstream trigger inflammation, leading to blood clots and leaky blood vessels. When the blood flow is impaired, the lack of transport can impair needed nutrients and oxygen to internal organs. Without timely evaluation and intervention, sepsis morphs quickly and can lead to tissue damage, organ failure, and death.
Although usually stemming from a bacterial infection, viral infections such as COVID-19 and the flu have been known to begin the rapid progression from sepsis to severe sepsis, and unfortunately, to septic shock.
According to the Centers for Disease Control and Prevention (CDC), there are over 1.5 million cases of sepsis annually. The condition leads to more than 270,000 deaths each year.
- Someone in the United States is diagnosed with sepsis every 20 seconds.
- The risk of dying from sepsis increases by as much as 8% for every hour of delayed treatment.
- On average, approximately 30% of patients diagnosed with severe sepsis do not survive.
September is Sepsis Awareness Month. Not many years ago, the CDC estimated less than 50% of Americans had ever heard about sepsis or facts about the prevalence and preventability of this insidious and alarming condition.
Unfortunately, many people have loved ones who currently reside in nursing homes and assisted living facilities where any infection is a constant concern for falling prey to sepsis. Early recognition is critical.
Levin & Perconti has successfully represented families in Chicago, and throughout the state, in cases of nursing home neglect. Contact us if you have questions or concerns about the safety of a family member currently residing in a community living facility.Classification of Sepsis in Three Stages
Sepsis happens in three stages, namely sepsis, severe sepsis, and septic shock. Read more about these stages and the timeline to better understand how to help yourself or your loved one when the condition arises.
Stage 1: Sepsis
Sepsis can be hard to identify in its early stages, but common symptoms that show evidence of the disease during its first stage include:
- A high fever above 101℉ (38℃) or low temperature below 96.8℉ (36℃)
- A heart rate above 90 beats per minute
- A bacterial infection, fungal infection, or viral infection confirmed through positive blood culture results
- Rapid breathing rate higher than 20 breaths per minute
You must have at least two of these early symptoms of sepsis before a medical professional makes a diagnosis. The sooner you receive medical care, the higher your chances for survival. If caught before it affects vital organs, it's possible to treat the infection with antibiotic therapy. Most people who have sepsis detected at this stage make a full recovery.
Stage Two: Severe Sepsis
The second stage of sepsis, severe sepsis, is diagnosed when life-threatening organ dysfunction happens characterized by symptoms or vital signs, including:
- Abnormal heartbeat or poor cardiac output
- Decreased urine output
- Sudden changes in mental state
- Difficulty breathing or acute respiratory distress syndrome
- Abnormal pain
- Chills due to reduced body temperature
- Extreme weakness
- Unconsciousness and confusion
Any infection in the body can lead to sepsis. Kidney, bloodstream, or abdominal area infections, as well as pneumonia, can put you at a greater risk of this condition. You must exhibit at least one of these symptoms of severe sepsis to be diagnosed with severe-stage sepsis syndrome. Urine output is one factor measured by doctors in the SSC Sepsis 6 bundle immediately after an early diagnosis.
Stage Three: Septic Shock
Patients transitioning to stage 3 are said to be in septic shock, the most dangerous phase of sepsis. Despite medical intervention, low blood pressure is present, and there are elevated serum lactate levels in patients with septic shock. Lactate is a chemical naturally produced by the body to fuel the cells during times of stress. Its presence in elevated quantities is commonly associated with sepsis and severe inflammatory response syndrome.
Your doctor will use a mean arterial pressure calculation to determine your blood pressure level. Usually, the reading should be at least 60 mm HG or higher to ensure enough blood flow to the vital organs. A dramatic drop in these levels can be life-threatening.
The symptoms of septic shock are similar to those in stage two, including perfusion abnormalities (e.g., elevated lactate levels). This stage has the highest chance of mortality, with estimates ranging between 30% and 50%.
Sepsis can have lingering consequences in the form of post-sepsis syndrome. This condition is particularly prevalent for patients confined to a hospital for an extended period or those who spent some time in an intensive care unit (ICU). Post-sepsis syndrome is the name given to a collection of symptoms that people may develop after sepsis or septic shock, which vary in severity and have both personal and economic consequences.
"At least one in six sepsis survivors have severe and persistent impairments, which include at least one new functional limitation on their activities of daily living." - Nursing Times
The physical consequences of post-sepsis syndrome include:
- Sleep disturbances
- Debilitating fatigue
- Hair loss
- Painful joints
- Lack of appetite
- Shortness of breath
- Renal failure
- Cardiovascular events
- Swelling of the legs and arms
Data reported by the National Institute Of Health indicates a survivor of sepsis is likely to experience "cognitive impairment, functional disabilities, and psychological deficits," including:
- Panic attacks
Ultimately, post-septic syndrome may lead to rehospitalization and reduced quality of life.
Sepsis progresses rapidly and can be a fast killer. Experts recommend that patients, their caregivers and families, and their healthcare providers consider sepsis a possibility. They emphasize the need for early recognition, treatment, and prevention of infections.
It's critical to seek treatment as soon as possible after diagnosis to prevent the condition from progressing. Studies reveal that the type and source of the infection largely influence the severity and progression of the situation.
In one clinical trial, results showed the risk of sepsis progression to be highest in people with bacteremia, followed by those with peritonitis and pneumonia. The category also includes Gram-positive cocci and Gram-negative bacteria in the blood. Blood cultures can establish the presence of these bacteria. The presence of these pathogens can increase the possibility of advancing to severe cases of sepsis or septic shock within the first month of being in the ICU.
It's important to note that the stage at which clinicians diagnose the condition also influences the chances of survival. Those initially diagnosed with septic shock clinically have a higher risk of death within 28 days. Progression from sepsis to severe sepsis or septic shock within the first week of diagnosis increases the chances of mortality.
Any person with an infection may potentially develop sepsis, although some conditions make one more susceptible. Although sepsis is not contagious, it does spread rapidly through the body. Early detection is key to recovery.
However, certain people, especially adults 65 years and older and people with chronic diseases or medical conditions, are at a higher risk. Those most likely to show signs and symptoms are:
- Geriatric population: CDC evaluation found that greater than 90% of adults who developed sepsis had a previous serious health condition that could increase their risk factor for sepsis and septic shock.
- Those with chronic health issues (cancer, diabetes, respiratory illness, kidney disease, AIDS, liver disease) or a weakened immune system
- Those undergoing chemotherapy
- Those with metabolic acidosis
- Recent surgical patients
- Organ donor recipients
- Former sepsis patients
- Patients currently in a hospital, especially in an intensive care unit (ICU)
- People with a recent history of hospitalization
- Infants with a weakened immune system
Children younger than one year are also at high risk, which curtails their survival rates. Exposure to invasive devices like breathing tubes, equipment used to administer intravenous (IV) fluids, and catheters is also a risk factor for developing sepsis. Blood poisoning and germs that cause chronic illness can also lead to sepsis.
Signs that you or your loved one may be suffering from sepsis include:
- Increased breathing rate
- Altered mental status
- Gastrointestinal distress
- Urinary tract infection (UTI)
Newborns and Sepsis
Neonatal sepsis happens when your baby gets an infection in the blood within the first month of their life. Sepsis in newborns is classified depending on the timing of the disorder, whether it was contracted during birth (early onset) or after birth (late-onset). The timing is crucial as it helps the doctor determine the kind of treatment to administer, for example, antibiotics.
Babies born with low birth weight or prematurely have a higher risk of late sepsis onset. The increased risk is because of their body's immune system that's still immature. The signs of sepsis in a newborn may be subtle and not specific, including:
- Abdominal pain and swelling
- Not feeding well
- Low body temperature
- Apnea or temporary stopping of breathing
- Poor skin circulation
Sepsis in newborns is one of the leading causes of infant death. However, when caught early and administered quick treatment, babies will recover completely and not have other problems.
Maternal universal screening, physical examination, and appropriate neonatal screening have played a significant role in decreasing the risk of pediatric sepsis.
Seniors and Sepsis
Older adults have a higher risk of sepsis because they:
- Often have a reduced immunity that slows down wound healing
- Often have other conditions like arthritis or diabetes
- Are at a higher risk of having malnutrition
- Have more frequent infections that can lead to sepsis
Sepsis usually develops from a urinary or respiratory tract infection like pneumonia (can be detected through a chest x-ray) or the flu. COVID-19 also emerged as a significant risk factor for sepsis, mainly affecting older adults.
Unfortunately, the early signs of sepsis may not be easy to spot in older people, causing the condition to progress more rapidly. The Sepsis Alliance reports that people over 65 are 13 times more likely to end up in the emergency room with sepsis than those under 65. Sixty-three percent of people over 60 are also at risk of getting sepsis upon entering the ICU.
When an older person recovers from sepsis, it's a fact that they also have an increased risk of:
- Getting a repeat specific infection on common sites of infection through exposure to an infectious agent
- Organ damage and heart failure
- Post-traumatic stress disorder (PTSD)
- Chronic pain and fatigue
- Systemic inflammatory response syndrome
Overall, it's crucial to recognize the signs of sepsis in older people and ensure prompt treatment to reduce the risk of progression.
As sepsis worsens, it impairs blood flow to vital organs like the heart, brain, and kidneys, leading to their impairment. Sepsis is also a common cause of abnormal blood clotting, resulting in burst blood vessels or small blood clots that damage or destroy tissues, often leading to complications, including:
- Permanent brain damage
- Tissue damage or death
- Kidney failure
- Permanent damage in the lungs induced by mechanical ventilation
- Damage to the heart valve
A sequential organ failure assessment score is usually necessary to quantify the number of failed organs and the severity.
Sepsis is a medical emergency, and you should get immediate medical attention from your healthcare provider after diagnosis. Early diagnosis and treatment can help increase the general life expectancy of people suffering from the condition. While most people recover from mild sepsis, the mortality rate for septic shock is approximately 40%. Additionally, a person who survives severe sepsis is at a higher risk of getting future infections.
How long can you have sepsis before it kills you?
Research conducted at the Institute of Healthcare Policy and Innovation at the University of Michigan shows that many people die in the months and years following sepsis diagnosis and treatment. Forty percent of the study subjects who survived the first 30 days under hospital care died within two years. However, it's not clear if the patients die because of the incidence of sepsis or from other health conditions they may have.
When treatment or medical intervention is missing, sepsis is a leading cause of death, more significant than breast cancer, lung cancer, or heart attack. Research shows that the condition can kill an affected person in as little as 12 hours. Being empowered with the correct information to notice the tell-tale signs and receive immediate treatment could save a life.Sepsis Seems To Be On The Rise
Sepsis is a leading cause of death in U.S. hospitals. This growing trend might be due to the increase in our aging population, understaffing in health care facilities, or even the prevalence of antibiotic-resistant pathogens. Nevertheless, preventing infection is a major concern and one that the medical industry can't ignore.
Based on research data, the Sepsis Alliance estimates that as many as 80% of sepsis deaths could be prevented with rapid evaluation and treatment. For every hour treatment is delayed, the risk of death increases by as much as 8%. Therefore, educating the public about sepsis is paramount to saving lives.Nursing Home Residents at Risk
According to an investigation published by the Advisory Board, 25,000 nursing home residents die annually after transferring from the hospital suffering from the initial stages of sepsis. The investigation continued to reveal that a large majority of the nursing homes in the United States don't prevent wounds and bedsores that lead to severe stage sepsis. Seventy-two percent of these homes have received citations for not being proactive in infection-control programs.
Sadly, sepsis can sometimes be a warning sign of nursing home neglect or abuse. Nursing homes have a mandate to take care of elderly residents and ensure they're safe, well-cared for, and receive their medications on time.
Alarming Data About Sepsis In Community Living Facilities
Community living can be a breeding ground for infection. NBC 5 Chicago reported: "Illinois nursing homes fall below national norms for risks of pressure sores or failure to properly treat them. Inspectors have cited about 60% of Illinois nursing homes for this deficiency."
Skilled nursing and assisted living facilities are required to ensure the safety of the residents in their care. Infection control policies and procedures are not discretionary issues.
Gabby's Law was enacted to honor the memory of a 5-year-old girl who succumbed to sepsis almost 12 years ago from an undetected tick bite. This legislation requires Illinois hospitals to:
- Initiate a policy and procedure for recognizing and treating sepsis
- Adequately train staff in the process
- Collect sepsis data to improve quality of care
Nursing home patients are highly susceptible to infection and sepsis, mainly due to advanced age, comorbidities, and increasing mobility issues. Sepsis is one of the main reasons to transfer a resident of a nursing facility to a hospital.
Sepsis might not always be preventable, but seeking treatment immediately is paramount to survival. Unfortunately, many victims of sepsis don't survive. When death is the end result of negligence, it constitutes a wrongful death, and it's often compensable. Wrongful death claims add additional layers of complexity to personal injury law.
There's a definite legal hierarchy regarding who's eligible to file a claim after someone dies from negligence, typically a surviving spouse, child, or parent, or if no surviving relatives step forward, a personal representative of the decedent's estate might be eligible to file. In addition to medical bills and funeral expenses, it's sometimes possible to receive compensation for mental anguish, loss of companionship, and the anticipated value of lost wages and benefits.
Sadly, there's no amount of money sufficient to make up for an unexpected loss of life from negligence. However, we hope that after the untimely death of an elderly loved one, family members can gain a margin of financial security and some type of closure from a wrongful death claim.
If a skilled nursing facility fails in its legal responsibility to ensure the welfare and safety of those entrusted to their care, they may be found liable for the consequences of their actions. Reasons for culpability include:
- Hiring unqualified employees
- Not providing sufficient training and supervision
- Being found understaffed
- Violation of state and federal regulations
Our legal team takes an aggressive approach to combat the toll nursing home negligence has on entire families. If your loved one suffered injuries or died from sepsis due to nursing home negligence, contact us today to determine if you have a valid case and if you're eligible to receive compensation to ease the financial burdens associated with the harm.What Damages Can I Recover in a Nursing Home Negligence Claim?
Persons or families harmed entirely by someone else's negligence or intent in Illinois may be eligible to receive compensation for economic and non-economic damages.
Economic damages include:
- Medical expenses, past and future
- Rehabilitation costs
- Property damage repair or replacement
- Accommodations and assistive devices
- Renovations to make a home or vehicle accessible
- Lost wages and loss of employment opportunities
- The loss of Social Security benefits
- The loss of health insurance
- Other verifiable monetary losses
Non-economic damages include:
- Pain and suffering
- Loss of companionship or consortium
- Loss of enjoyment of life
- Changes in family relationships
- Emotional distress
- Disfigurement or permanent physical impairment
Sepsis is a medical emergency that can't go untreated. If your elderly loved one develops an initial infection, especially due to staff negligence, that leads to sepsis while in a nursing home, you may have a valid lawsuit against the facility. Don't hesitate to reach out to a lawyer if you notice:
- Inadequate cleaning and sanitization of the kitchen, restrooms, and common areas
- Downplaying of medical complaints when there's an urgent need for medical help
- Not bathing residents regularly
- Dirty bed linens that aren't changed regularly
You may be able to seek compensation for the damages with the help of a nursing home abuse lawyer. Levin and Perconti is a nationally recognized firm with experience in nursing home abuse cases, and we're here to help your family. Reach out to us today to schedule a free case consultation.