Sepsis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]
Overview
There are many complications associated with sepsis, especially because it is a systemic phenomenon. Sepsis is a severe condition, and the prognosis of the patient will depend greatly on the condition and overall health of the patient. Many factors, such as age, contribute to the overall prognosis.
Complications
- Infection is the invasion of normally sterile host tissues by a microbial pathogen.
- Bacteremia is the presence of bacteria in the blood. Bacteremia can occur in sepsis and other serious diseases such as infective endocarditis, bacteremic pyelonephritis or pneumonia and meningitis but it may also be a harmless and transient condition.
- Viremia is the presence of viruses in the blood.
- Septic joint is an infection of a joint; it is associated with bacteremia and trauma.
- Disseminated intravascular coagulation (DIC) can be the result of sepsis
- Acute tubular necrosis (ATN) leading to acute renal failure, can be the result of hypoperfusion of the kidneys in sepsis (i.e. not enough blood gets to the kidney and they stop working properly)
- Arrhythmia is an abnormal heart rhythm; it can be the result of sepsis.
- Ileus or ischemic colitis can be the result (hypoperfusion) or cause of sepsis
- Multiple organ dysfunction syndrome can be the result of sepsis
- Meningitis, infection of the tissue that covers the brain and spinal cord, can be a complication or cause of sepsis
- Osteomyelitis is an infection of the bone; it can be the cause or result of sepsis
- Endocarditis, infection of the inner surface of heart which is in contact with blood, can also be a complication or cause of sepsis
- Pyaemia — causes abscesses
Prognosis
Prognosis can be estimated with the MEDS (Mortality in Emergency Department Sepsis) score.[1] This MEDS score will be a calculation of the following criteria:
- Altered mental status
- Lower respiratory infection
- Granulocytic bands > 5% of WBC
- Patient older than 65
- Shock from sepsis
- Platelet count below 150,000
- Terminal illness with an immediate possibility of death within one month
- Hypoxia
- Tachypnea
Point System[2]
The precise scoring system for the MEDS score is as follows:
- Rapidly progressing terminal co-morbid illness - 6 points
- If the patient is older than 65 years of age - 3 points
- If the granulocytic bands are greater than 5% - 3 points
- If the patient has tachypnea or hypoxia - 3 points
- If the patient is in shock - 3 points
- If the patient has a platelet count of less than 150,000 mm3 - 3 points
- If the patient has an altered mental status - 2 points
- If the patient is a resident of a nursing home - 2 points
- If the patient has a lower respiratory infection - 2 points
Point Correlation[2]
The total score will be added up and that total will correlate to the mortality percentage with a 95% confidence interval. The following are the point ranges associated with various mortality percentages.
- 0-4 points total - 0.6% mortality rate
- 5-7 points total - 5% mortality rate
- 8-12 points total - 19% mortality rate
- 13-15 points total - 32% mortality rate
- 15+ points total - 40% mortality rate
References
- ↑ Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW (2003). "Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule". Crit. Care Med. 31 (3): 670–5. doi:10.1097/01.CCM.0000054867.01688.D1. PMID 12626967.
- ↑ 2.0 2.1 "Risk Stratifying the Potentially Septic Patient in the ED". Retrieved 2012-04-20.