Although current dogma explains sepsis as a sustained, excessive inflammatory response, Hotchkiss bases his approach on evidence to the contrary. His studies, which include examination of cells extracted from patients soon after death, suggest that the symptoms of sepsis persist because during the course of the illness, the immune system shifts from an overreaction to a kind of collapse—instead of doing too much, it does too little. If that is correct, Hotchkiss says, then immune-stimulating compounds such as interleukin-7, which are already used in cancer treatment, could prevent deaths from sepsis—an idea that traditional sepsis researchers might view as adding fuel to a fire.
With no new drugs on the horizon, some investigators urge a shift in focus from discovering pharmaceutical treatments to the importance of critical care, improved long-term care and increased public awareness. They point out that while the death rate from sepsis remains high, it has decreased over time, not because of new treatments for sepsis but because doctors have in general become better at saving the lives of critically ill patients. Clinicians should pay more attention to the four fifths of sepsis patients who survive, some researchers argue. Many survivors have profound disabilities, such as amputated limbs, blindness and cognitive problems. O'Brien, the Sepsis Alliance adviser, emphasizes that public awareness encourages early recognition, which greatly enhances the chances of recovery.
Early Warning Signs
A diagnosis of sepsis requires at least two of these symptoms, as well as a suspected or confirmed infection of bacteria, viruses or fungi. The earliest symptoms of sepsis often mimic a mild infection, but the disease can worsen swiftly, ravaging the body.
✓ Quickened breathing (respiratory rate > 20 breaths/min)
✓ Increased heart rate (> 90 beats/min)
✓ Unusually high or low core body temperature (< 36° Celsius or > 38° C)
✓ Unusually high or low numbers of white blood cells
This article was originally published with the title Shock to the System.