A Silent Killer Slate April 2016
- There is no easy way to diagnose sepsis. The good news is you probably don’t have it, but here’s how to ask your doctor if you’re worried
- Between 16% and 49 % who get Sepsis will die.
- Until recently, the CDC failed to even mention sepsis in it’s A–Z index of medical terms
- Sepsis costs the U.S. more than $20 billion per year
Table of contents
- See also VitaminDWiki
- 2.9 X more likely to recover from Septic Shock in 24 hours if have higher level of vitamin D (> 10 ng?) - 2017
- Infants with sepsis have very low Vitamin D levels – Aug 2014
- 200,000 and 400,000 IU of vitamin D reduced septic shock - RCT June 2015
- Meta-analysis concludes: Sepsis 1.8 X more likely if low vitamin D - June 2015
- Vitamin D - a new hope for septic shock - July 2013
- Vitamin D might treat sepsis - July 2011
- Vitamin D reduces Sepsis (abstract only) – Dec 2014
- See also web - nothing about vitamin D
- Medicine.Net description of Sepsis and related terms
- Sepsis has doubled in a decade (while Vitamin D levels have dropped)
- A few PubMed publications on Sepsis and Vitamin D - Sept 2106
- Sepsis treated with Intravenous Vitamin C, Thiamine, and hydrocortisone - March 2017
See also VitaminDWiki
- Sepsis is 13 X more likely if poor Vitamin D Receptor – April 2017
- Severe Sepsis associated with very low vitamin D – Sept 2016
- Septic patients vitamin D so low that small changes did not matter – June 2011
- all items: Low vitamin D due to surgery or trauma
- Veterans with enough vitamin D were almost 2X more likely to survive ICU – Oct 2010
If have more than 20 ng/ml almost 2X more likely to survive ICU, AND almost 2X less likely to stay > 3 days in ICU
- Google Search for SEPSIS at VitaminDWiki 219 items as of March 2014
- MRSA inpatient cost 2X higher if less than 20 ng vitamin D – June 2011
- Staph infection reduced 50 percent when have more than 30 ng of vitamin D – Aug 2011
- More sepsis deaths in those entering hospital with low vitamin D – Jan 2014
- All items in category Inflammation and Vitamin D
- Sepsis bacteria can be killed by blue as well as UV light – Jan 2013
- Being vitamin D deficient in the ICU is not good - Feb 2012
- Septic shock and low vitamin D in children – Oct 2011
- 2X more likely to get hospital infection if low vitamin D (10 ng) when enter – Oct 2013
- Vitamin D and infectious diseases like RTI, TB and Sepsis – Nov 2014
- Reducing vitamin D reduces cathelicidin which reduces immunity
- Several papers on Vitamin D for critically ill children in Journal of Pediatrics – Aug 2012
2.9 X more likely to recover from Septic Shock in 24 hours if have higher level of vitamin D (> 10 ng?) - 2017
Effect of Severe Vitamin D Deficiency at Admission on Shock Reversal in Children With Septic Shock.
J Intensive Care Med. 2017 Jan 1:885066617699802. doi: 10.1177/0885066617699802. [Epub ahead of print]
Sankar J1, Ismail J1, Das R1, Dev N2, Chitkara A3, Sankar MJ1.
1 Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
2 Department of Medicine, PGIMER, Dr RML Hospital, New Delhi, India.
3 Department of Biochemistry PGIMER, Dr RML Hospital, New Delhi, India.
To evaluate the association of severe vitamin D deficiency with clinically important outcomes in children with septic shock.
We enrolled children ≤17 years with septic shock prospectively over a period of 6 months. We estimated 25-hydroxyvitamin D 25 (OH) D levels at admission and 72 hours. Severe deficiency was defined as serum 25 (OH) <10 ng/mL. We performed univariate and multivariate analysis to evaluate association with clinically important outcomes.
Forty-three children were enrolled in the study. The prevalence of severe vitamin D deficiency was 72% and 69% at admission and 72 hours, respectively. On univariate analysis, severe vitamin D deficiency at admission was associated with lower rates of shock reversal, 74% (23) versus 25% (3); relative risk (95% confidence interval CI): 2.9 (1.09-8.08), at 24 hours and greater need for fluid boluses (75 vs 59 mL/kg). On multivariate analysis, nonresolution of shock at 24 hours was significantly associated with severe vitamin D deficiency after adjusting for other key baseline and clinical variables, adjusted odds ratio (95% CI): 12 (2.01-87.01); 0.01.
The prevalence of severe vitamin D deficiency is high in children with septic shock admitted to pediatric intensive care unit. Severe vitamin D deficiency at admission seems to be associated with lower rates of shock reversal at 24 hours of ICU stay. Our study provides preliminary data for planning interventional studies in children with septic shock and severe vitamin D deficiency.
PMID: 28335672 DOI: 10.1177/0885066617699802 Publisher wants $40 for the PDF
Infants with sepsis have very low Vitamin D levels – Aug 2014
Lower vitamin D levels are associated with increased risk of early-onset neonatal sepsis in term infants
Journal of Perinatology (2015) 35, 39-45;doi:10.1038/jp.2014.146;published online 7 August 2014
M Cetinkaya1, F Cekmez2, G Buyukkale1, T Erener-Ercan1, F Demir1, T Tunc2, FN Aydin3 and G Aydemir2
OBJECTIVE: To evaluate the effect of vitamin D levels on early-onset sepsis (EOS) in term infants.
STUDY DESIGN: Fifty term infants with clinical and laboratory findings of EOS (study group) and 50 healthy infants with no signs of clinical/laboratory infection (control group) were enrolled. Blood was drawn at the time of admission during the first 3 postnatal days of life in both groups for measurement of 25-hydroxyvitamin D (25-OHD) levels.
RESULT: Maternal and neonatal 25-OHD levels (22.2/8.6 ng ml-1, respectively) in the study group were significantly lower than those of the control group (36.2/19 ng ml-1, respectively, P < 0.001). A positive correlation was detected between maternal and neonatal 25-OHD levels. Severe vitamin D deficiency was significantly more common in the sepsis group.
CONCLUSION: Lower maternal and neonatal 25-OHD levels are associated with EOS. These data suggest that adequate vitamin D supplementation during pregnancy may be helpful to prevent EOS in term neonates.
Clipped from PDF
- “ The incidence of neonatal sepsis varies between 1 and 8 neonates per 1000 live births.3
- “It is estimated to cause almost 1 million deaths that accounts for more than 25% of neonatal deaths worldwide.4
- “Newborns are more susceptible to infections as both innate and adaptive immune systems are not entirely developed.”
200,000 and 400,000 IU of vitamin D reduced septic shock - RCT June 2015
Effect of Cholecalciferol Supplementation on Vitamin D Status and Cathelicidin Levels in Sepsis: A Randomized, Placebo-Controlled Trial.
Critical Care Medicine:, Post Author Corrections: June 17, 2015, doi: 10.1097/CCM.0000000000001148
Quraishi, Sadeq A. MD, MHA, MMSc; De Pascale, Gennaro MD; Needleman, Joseph S. BS, BA; Nakazawa, Harumasa MD, PhD; Kaneki, Masao MD, PhD; Bajwa, Ednan K. MD, MPH; Camargo, Carlos A. Jr MD, DrPH; Bhan, Ishir MD, MPH
Objectives: To compare changes in vitamin D status and cathelicidin (LL-37) levels in septic ICU patients treated with placebo versus cholecalciferol.
Design: Randomized, placebo-controlled, trial.
Setting: Medical and surgical ICUs of a single teaching hospital in Boston, MA.
Patients: Thirty adult ICU patients.
Interventions: Placebo (n = 10) versus 200,000 IU cholecalciferol (n = 10) versus 400,000 IU cholecalciferol (n = 10), within 24 hours of new-onset severe sepsis or septic shock.
Measurements and Main Results: Blood samples were obtained at baseline (day 1) and on days 3, 5, and 7, to assess total 25-hydroxyvitamin D, as well as vitamin D-binding protein and albumin to calculate bioavailable 25-hydroxyvitamin D. Plasma LL-37 and high-sensitivity C-reactive protein levels were also measured. At baseline, median (interquartile range) plasma 25-hydroxyvitamin D was 17 ng/mL (13-22 ng/mL) and peaked by day 5 in both intervention groups.
Groups were compared using Kruskal-Wallis tests. Relative to baseline, on day 5, median change in biomarkers for
200,000 IU cholecalciferol, and
400,000 IU cholecalciferol groups, respectively,
were as follows:
- 1) total 25-hydroxyvitamin D, 3% (-3% to 8%), 49% (30-82%), and 69% (55-106%) (p < 0.001);
- 2) bioavailable 25-hydroxyvitamin D, 4% (-8% to 7%), 45% (40-70%), and 96% (58-136%) (p < 0.01); and
- 3) LL-37: -17% (-9% to -23%), 4% (-10% to 14%), and 30% (23-48%) (p = 0.04).
Change in high-sensitivity C-reactive protein levels did not differ between groups.
A positive correlation was observed between bioavailable 25-hydroxyvitamin D and LL-37 (Spearman [rho] = 0.44; p = 0.03) but not for total 25-hydroxyvitamin D and LL-37.
Conclusions: High-dose cholecalciferol supplementation rapidly and safely improves 25-hydroxyvitamin D and bioavailable 25-hydroxyvitamin D levels in patients with severe sepsis or septic shock. Changes in bioavailable 25-hydroxyvitamin D are associated with concomitant increases in circulating LL-37 levels. Larger trials are needed to verify these findings and to assess whether optimizing vitamin D status improves sepsis-related clinical outcomes.
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Publisher wants $53 for the PDF
Note by VitaminDWiki :LL-37 is an antimicrobial peptide
Meta-analysis concludes: Sepsis 1.8 X more likely if low vitamin D - June 2015
Significant association between vitamin D deficiency and sepsis: a systematic review and meta-analysis.
BMC Anesthesiol. 2015 Jun 4;15(1):84. doi: 10.1186/s12871-015-0063-3.
Upala S1,2, Sanguankeo A3,4, Permpalung N5.
A number of observational studies have found an association between low vitamin D levels and risk of sepsis. We conducted a systematic review and meta-analysis to determine the overall estimate of risk.
This was a systematic review and meta-analysis conducted by online searches (CENTRAL, PubMed/MEDLINE, and EMBASE) was registered in PROSPERO (CRD42014014767). Primary outcome was incidence, prevalence, relative risk or odds ratio of having sepsis or bloodstream infection between patients with vitamin D deficiency and controls.
The initial search yielded 647 articles. Twenty-one articles underwent full-length review and data were extracted from 10 observational studies. Pooled odds ratio of sepsis in participants with vitamin D deficiency was 1.78 (95 % confidence interval CI = 1.55 to 2.03, p < 0.01) compared with controls in studies that reported participant numbers and was 1.45 (95 % CI = 1.26 to 1.66, p < 0.01) in studies that reported an adjusted odds ratio of vitamin D deficiency for developing sepsis. Statistical between-study heterogeneity was low (I(2) = 0 % and 5 %, respectively). Standardized mean difference of 25-hydroxyvitamin D levels in patients with sepsis and controls was -0.24 (95 % CI = -0.49 to 0.00, p = 0.05) and lower in the sepsis group compared with non-sepsis or control participants. The statistical between-study heterogeneity (I(2)) was 0 %.
Vitamin D deficiency were associated with an increased susceptibility of sepsis.
Download the PDF from VitaminDWiki
Vitamin D - a new hope for septic shock - July 2013
Is vitamin D supplementation a new hope for the therapy of the septic shock?
Endocr Regul. 2013 Jul;47(3):133-6.
Yılmaz H, Sahiner E, Darcin T, Celik HT, Bilgic MA, Akcay A.
Vitamin D is mainly known for its traditional role in the bone mineralization and calcium homeostasis. Recent studies have shown that vitamin D receptors (VDR) are present in almost all the tissues and cells in the human body. In addition, several studies have revealed that vitamin D is important in immunomodulation, regulation of inflammation and cytokines, cell proliferation, cell differentiation, apoptosis, angiogenesis, muscle strength, and muscle contraction. Patients with sepsis have high mortality rate and high deficiency in vitamin D. In addition, septic patients have decreased vitamin D binding-protein (DBP) levels which further exacerbate the vitamin D deficiency. The role of vitamin D treatment in sepsis syndrome has been evaluated in animal model of sepsis where 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] administration was associated with improved blood coagulation parameters in sepsis associated with a disseminated intravascular coagulation.
Vitamin D treatment in vitro has also been demonstrated to modulate levels of the systemic inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6), as well as inhibit the lipopolysaccharide (LPS)-induced activation and vasodilation of vascular endothelium.
Vitamin D may enhance the induction of the antimicrobial peptides, cathelicidin and b-defensin, which have been described on mucosal and epithelial surfaces acting as the body's first line of defense against viral and bacterial pathogens.
Vitamin D supplementation may divert attention from relatively simple, natural, and low-cost methods of preventing severe sepsis and septic shock.
Further prospective, randomized and controlled clinical trials of adjunctive vitamin D therapy in patients who are vitamin D deficient are needed in the management of human sepsis syndrome.
Vitamin D might treat sepsis - July 2011
The role of vitamin D deficiency in sepsis and potential therapeutic implications.
J Infect. 2011 Jul 13.
Watkins RR, Yamshchikov AV, Lemonovich TL, Salata RA.
Division of Infectious Diseases, Akron General Medical Center, 224 West Exchange St., Suite 290, Akron, OH 44302, USA.
Recent studies have shown that vitamin D has important functions besides bone and calcium homeostasis.
Cells of the innate and adaptive immune system express vitamin D receptors and respond to stimulation by 1, 25-dihydroxyvitamin D.
Patients with sepsis have a high mortality rate as well as a high prevalence of vitamin D deficiency.
In addition, septic patients have decreased vitamin D binding protein levels which further exacerbates vitamin D deficiency.
Therapy with vitamin D in animal models of sepsis improves blood coagulation parameters in disseminated intravascular coagulation and modulates levels of systemic inflammatory cytokines including TNF-? and IL-6.
Vitamin D can enhance the induction of the antimicrobial peptides cathelicidin and ?-defensin which are found on mucosal and epithelial surfaces and act as the body's first line of defense against viral and bacterial pathogens.
Vitamin D is potentially an attractive therapeutic agent for sepsis given its low cost and low risk of toxicity and side effects.
Further prospective, randomized, controlled clinical trials of adjunctive vitamin D therapy in patients who are deficient are needed in the management of human sepsis syndrome.
Copyright © 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Vitamin D reduces Sepsis (abstract only) – Dec 2014
59: EFFECT OF CHOLECALCIFEROL SUPPLEMENTATION ON VITAMIN D STATUS AND CATHELICIDIN IN SEPSIS
Critical Care Medicine: December 2014 - Volume 42 - Issue 12 - p A1383 doi: 10.1097/01.ccm.0000457592.16092.b2
Quraishi, Sadeq1; DePascale, Gennaro MD2; Needleman, Joseph2; Camargo, Carlos Jr. MD, DrPH2; Bajwa, Ednan2; Bhan, Ishir MD, MPH2
Oral Abstract Session: Sepsis
More sepsis deaths when active vitamin D (Calcitrol) was low – May 2013 has the following
Sepsis associated with low vitamin D - April 2012 has the following
See also web - nothing about vitamin D
-  Download "Surviving Sepsis 2012" PDF from VitaminDWiki
referenced by Wikipedia
- Septic Shock - Medical dictionary has the following chart
Medicine.Net description of Sepsis and related terms
MedicineNet.com for Health and Medical Information
Medical Author:Charles Patrick Davis, MD, PhD
Medical Editor:Melissa Conrad Stöppler, MD
Sepsis (blood poisoning) facts
Sepsis is a potentially life-threatening medical condition that's associated with an infection; the infection's signs and symptoms must fulfill a minimum of two criteria of a systemic inflammatory response syndrome (SIRS).
Blood poisoning is a nonmedical term that usually refers to the medical condition known as sepsis.
The major SIRS criteria are an increased heart rate, fever, and increased respiratory rate; the young and the elderly may show other early signs and symptoms of sepsis sometimes before exhibiting SIRS criteria.
The majority of cases of sepsis are due to bacterial infection.
Sepsis is treated with hospitalization, intravenous antibiotics, and therapy to support any organ dysfunction.
Prevention of infections and early diagnosis and treatment of sepsis are the best ways to prevent sepsis or reduce the problems sepsis causes.
The prognosis depends on the severity of sepsis as well as the underlying health status of the patient; in general, the elderly have the worst prognosis.
What is blood poisoning?
Blood poisoning is a nonspecific term used mainly by nonmedical individuals that describes, in the broadest sense, any adverse medical condition(s) due to the presence of any toxic agent in the blood. Usually, the layperson using the term blood poisoning is referring to the medical condition(s) that arise when bacteria or their products (or both) reach the blood. Blood poisoning is not a medical term and does not appear in many medical dictionaries or scientific publications. However, when it is used, the correct medical term that most closely matches its intended meaning is sepsis. Many medical authors consider the terms blood poisoning and sepsis to be interchangeable, but the trend in the medical literature is to use the term sepsis.
What is sepsis?
Sepsis is a potentially dangerous or life-threatening medical condition, found in association with a known or suspected infection (usually caused by but not limited to bacteria) whose signs and symptoms fulfill at least two of the following criteria of a systemic inflammatory response syndrome (SIRS):
- elevated heart rate (tachycardia) >90 beats per minute at rest
- body temperature either high (>100.4 F or 38 C) or low (<96.8 F or 36 C)
- increased respiratory rate of >20 breaths per minute or a reduced PaCO2 (partial pressure of carbon dioxide in arterial blood level)
- abnormal white blood cell count (>12,000 cells/µL or <4,000 cells/µL or >10% bands [an immature type of white blood cell])
Patients who meet the above criteria have sepsis and are also termed septic. These criteria described above were proposed by several medical societies and may continue to be modified by other medical groups. For example, pediatric groups use the same four criteria listed above but modify the values for each to make the SIRS criteria for children. Other groups want to add criteria, but currently this is the most widely accepted definition.
Terms that are often used in place of sepsis are bacteremia, septicemia, and blood poisoning. However, bacteremia means the presence of bacteria in the blood; this can occur without any of the criteria listed above and should not be confused with sepsis. For example, you can brush your teeth and get bacteremia for a short time and have no SIRS criteria occur. Unfortunately, septicemia has had multiple definitions over time; it has been defined as bacteremia, blood poisoning, bacteremia leading to sepsis, sepsis, and other variations. Although septicemia appears frequently in the medical literature, a reader must be sure which definition the author is using. Some experts suggest the terms blood poisoning and septicemia not be used since they are poorly defined, but it is difficult for the medical community to disregard such terms that have been used for many decades.
Why are there so many diseases with "sepsis," "septic," "septicemia," or "blood poisoning" in their name?
Unfortunately, both medical personnel and laypeople have used these terms interchangeably and then linked them to either a particular organism (usually bacterial) that can cause sepsis, to a site in the body in which an infection originates that leads to sepsis, or to a clinical situation that leads to sepsis as described above. For example, meningococcal sepsis, meningococcal septicemia, septic meningitis, and meningococcal blood poisoning can refer to the same entity, an infection of the patient by the bacteria Neisseria meningitidis that has spread from the meninges (brain membranes) to the bloodstream, resulting in the patient having at least two of the four criteria outlined above for sepsis. Common examples of a clinical situation used in the same way are puerperal sepsis, puerperal septicemia, puerperal or childbirth blood poisoning, and maternal septicemia postpartum. All four terms represent infection that occurs during the puerperium (time around the delivery of a baby) that leads to sepsis criteria for the patient. The infectious agent is not described when the body site or situation is linked to "sepsis" or the other terms.
The following is a short partial list of both organism and organ system (and organ-related) terms that are seen in both the lay and medical literature:
- MRSA sepsis: sepsis caused by methicillin-resistant Staphylococcus aureus bacteria
- VRE sepsis: sepsis caused by vancomycin-resistant Enterococcus species of bacteria
- rosepsis: sepsis originating from a urinary tract infection (UTI)
- wound sepsis: sepsis originating from an infection of a wound
- neonatal sepsis or septicemia: sepsis seen in newborns, usually in the first four weeks after birth; sepsis neonatorum means the same as neonatal sepsis
- septic abortion: an abortion due to infection with sepsis in the mother
There are many more examples of linking terms to sepsis (for example, AIDS, tattoo, spider bite). Occasionally, terms like hemorrhagic septicemia are used to describe a symptom (internal bleeding) that occurs with sepsis. The trend in medicine currently is to decrease the use of the terms septicemia and blood poisoning in favor of the terms sepsis or septic, because sepsis is defined most concisely.
What causes sepsis?
The majority of cases of sepsis are due to bacterial infections, some are due to fungal infections, and very few are due to other causes of infection or agents that may cause SIRS. The infectious agents, usually bacteria, begin infecting almost any organ location or implanted device (for example, skin, lung, gastrointestinal tract, surgical site, intravenous catheter, etc.). The infecting agents or their toxins (or both) then spread directly or indirectly into the bloodstream. This allows them to spread to almost any other organ system. SIRS criteria result as the body tries to counteract the damage done by these blood-borne agents.
Common bacterial causes of sepsis are gram-negative bacilli (for example, E. coli, P. aeruginosa, E. corrodens, and Haemophilus influenzae in neonates). Other bacteria also causing sepsis are S. aureus, Streptococcus species, Enterococcus species and Neisseria; however, there are large numbers of bacterial genera that have been known to cause sepsis. Candida species are some of the most frequent fungi that cause sepsis. In general, a person with sepsis can be contagious, so precautions such as hand washing, sterile gloves, masks, and clothing coverage should be considered depending on the patient's infection source.
What are the risk factors for sepsis?
The following groups are at increased risk for sepsis:
- The very young and the elderly are at greatest risk
- People in an intensive-care unit
- People with weakened or compromised immune systems
- People with devices such as IV catheters, breathing tubes, or other devices
- People with extensive burns
- People with severe trauma
What are the signs or symptoms of sepsis (blood poisoning)?
The adult patient should have a proven or suspected source of an infection (usually bacterial) and have at least two of the following problems: an elevated heart rate (tachycardia), either a high (fever) or low temperature (hypothermia), rapid breathing (>20 breaths per minute or a reduced PaCO2 level), or a white blood cell count that is either high, low, or composed of >10% band (immature) cells. In most cases, it is fairly easy to ascertain heart rate (count pulse per minute), fever or hypothermia with a thermometer, and to count breaths per minute even at home. It may be more difficult to prove a source of infection, but if the person has symptoms of infection such as productive cough, dysuria, fevers, or a wound with pus, it is fairly easy to suspect that a person with an infection may have sepsis. However, determination of the white blood cell count and PaCO2 is usually done by a lab. In most cases, the definitive diagnosis of sepsis is made by a physician in conjunction with laboratory tests.
Elderly patients have similar symptoms to those stated for adults, but the first apparent symptoms are often confusion along with chills, weakness, possibly faster breathing, and a dusky skin appearance. Pediatric patients (infants, toddlers, and children) also may develop similar symptoms to those in adults, but the most common symptoms are fever and reduced urine output. Children may show signs of lethargy and decreased age-appropriate mental status. Neonatal sepsis (sepsis neonatorum) is suspected in neonates up to 28 days old if the rectal temperature is 100.4 F or higher. Other signs and symptoms for neonatal sepsis include fever in the mother at time of delivery, cloudy or smelly amniotic fluid, abnormal vital signs, seizures, and projectile vomiting.
Some authors consider red lines or red streaks on the skin to be signs of sepsis. However, these streaks are due to local inflammatory changes in either local blood vessels or lymphatic vessels (lymphangitis). The red streaks or lines are worrisome as they usually indicate a spreading infection that can result in sepsis.
Septic shock is a condition in which overwhelming infection causes a dangerous drop in systolic blood pressure (hypotension). Additional symptoms that may accompany the low blood pressure may include cool and pale extremities, dizziness or lightheadedness, low or absent urine output, shortness of breath, rapid heart rate, behavioral changes, and low or high body temperature.
How is sepsis diagnosed?
Clinically, the patient needs to fit at least two of the SIRS criteria listed above and have a suspected or proven infection. This is a screening tool to help physicians presumptively diagnose sepsis early in the disease process. Definitive diagnosis depends on a positive blood culture for an infectious agent and at least two of the SIRS criteria. However, two subsets of the four criteria depend on lab analysis: white blood cell examinations and PaCO2. These subset criteria, like blood cultures, are measured in clinical laboratories. Researchers are currently investigating other blood tests to diagnose early sepsis.
There are other diagnoses that indicate the severity of the patient's sepsis. Severe sepsis is diagnosed when the septic patient has organ dysfunction (for example, low or no urine flow, altered mental status). Severe sepsis can also include sepsis-induced hypotension (also termed septic shock) when the patient's blood pressure falls.
What is the treatment for sepsis?
In almost every case of sepsis, patients need to be hospitalized, treated with appropriate intravenous antibiotics, and given therapy to support any organ dysfunction. Sepsis can quickly cause organ damage and death; therapy should not be delayed as statistics suggest as high as a 7% mortality increase per hour if antibiotics are delayed in severe sepsis. Most cases of sepsis are treated in an intensive-care unit (ICU) of the hospital.
Appropriate antibiotics to treat sepsis are combinations of two or three antibiotics given at the same time; most combinations usually include vancomycin to treat many MRSA infections. However, once the infecting organism is isolated, labs can determine which antibiotics are most effective against the organisms, and those antibiotics should be used to treat the patient. In addition to antibiotics, two other major therapeutic interventions, organ-system support and surgery, may be needed. First, if an organ system needs support, the intensive-care unit can often provide it (for example, intubation to support lung function or dialysis to support kidney function). Secondly, surgery may be needed to drain or remove the source of infection. Amputation of extremities has been done to save some patients' lives.
A recent research report may alter a common treatment for septic shock. Because of the low blood pressure seen with septic shock, IV fluid boluses have been used to support the patient's blood pressure. However, a 2011 study in over 3,000 children in Africa with impaired perfusion (shock) showed that the fluid bolus treatments actually increased mortality (death rate) in the children. This surprising result has raised questions about how clinicians can best manage septic shock in the future. For example, in 2004, guidelines were published that "bundled" therapeutic methods (for example, blood cultures, antibiotic therapy, and fluid therapy) to treat sepsis in an initial six-hour period that included fluid boluses. This septic treatment bundle of techniques may need revision or reexamination.
What is the prognosis (outcome) with sepsis?
The prognosis of patients with sepsis is related to the severity or stage of sepsis as well as to the underlying health status of the patient. For example, patients with sepsis and no ongoing sign of organ failure at the time of diagnosis have about a 15%-30% chance of death. Patients with severe sepsis or septic shock have a mortality (death) rate of about 40%-60%, with the elderly having the highest death rates. Newborns and pediatric patients with sepsis have about a 9%-36% mortality rate. Investigators have developed a scoring system (MEDS score) based on the patient's symptoms to estimate prognosis.
What are the complications of sepsis?
There are a large number of complications that may occur with sepsis. The complications are related to the type of initial infection (for example, in lung infection [pneumonia] with sepsis, a potential complication could be a need for respiratory support) and the severity of sepsis (for example, septic shock related to a limb infection that could require limb amputation). Consequently, each patient is likely to have the potential for complications related to the source of sepsis; in general, the complications are due to organ dysfunction, damage, or loss. Death is usually due to multiorgan dysfunction (liver, kidney, or lung failure).
Physicians agree that the faster the patient with sepsis is diagnosed and treated, the better the prognosis and fewer complications, if any, for the patient.
How can sepsis (blood poisoning) be prevented?
Risk factors that lead to sepsis can be reduced by many methods. Perhaps the most important way to reduce the chance for sepsis is to first prevent any infections. Vaccines, good hygiene, hand washing, and avoiding sources of infection are excellent preventive methods. If infection occurs, immediate treatment of any infection before it has a chance to spread into the blood is likely to prevent sepsis. This is especially important in patients that are at greater risk for infection such as those who have suppressed immune systems, those with cancer, people with diabetes, or elderly patients.
What are some additional sources for information on sepsis (blood poisoning)?
- "Pediatric Sepsis," Medscape.com
- "Neonatal Sepsis (Sepsis Neonatorum)," MedicineNet.com
Medically reviewed by Martin E Zipser, MD; American Board of Surgery
- Dellinger, R., J. Carlet, H. Masur, et al. "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock." Crit Care Med. 32 (2004): 858-873.
- Maitland, K., S. Kiguli, R. Opoka, et al. "Mortality After Fluid Bolus in African Children with Severe Infection." N Engl J Med 364 (2011): 2483-2495.
Medically Reviewed by a Doctor on 2/9/2015; © 2015 MedicineNet, Inc. All rights reserved.
MedicineNet does not provide medical advice, diagnosis or treatment.
Sepsis has doubled in a decade (while Vitamin D levels have dropped)
A few PubMed publications on Sepsis and Vitamin D - Sept 2106
(thanks to Dr. Grant)
Inadequate vitamin D levels are associated with culture positive sepsis and poor outcomes in paediatric intensive care.
Onwuneme C1,2,3, Carroll A2, Doherty D2,4, Bruell H4, Segurado R5, Kilbane M6, Murphy N2, McKenna MJ3,6, Molloy EJ1,3,4,7,8.
This study aimed to assess vitamin D status, and its determinants, in paediatric patients with suspected sepsis who were admitted to a paediatric intensive care unit (PICU). We also investigated the association between vitamin D status and clinical outcomes.
Serum 25-hydroxy vitamin D (25OHD) and clinical determinants were prospectively assessed in children with suspected sepsis (<12 years old) admitted to the PICU. The relationship between 25OHD and clinical outcomes was evaluated. Vitamin D status was also assessed in control children of a similar age.
We enrolled 120 children with suspected sepsis admitted to the PICU and 30 paediatric controls. 25OHD was <50 nmol/L in 59% of the children admitted to the PICU and 25OHD was lower than in the controls (47 ± 29 vs 66 ± 26 nmol/L, p < 0.001). After adjusting for potential confounders, 25OHD was strongly associated with culture positive sepsis (p < 0.001), the paediatric index of mortality (p = 0.026) and the duration of mechanical ventilation (p = 0.008). There was a negative correlation between 25OHD and C-reactive protein (CRP): each 0.1% decrease in 25OHD increased CRP (p = 0.04).
Children admitted to the PICU with suspected sepsis had lower 25OHD than controls and inadequate 25OHD status was associated with confirmed sepsis and poor outcomes.
Eur J Pediatr. 2015 Jun;174(6):809-15. doi: 10.1007/s00431-014-2469-1. Epub 2014 Dec 12.
Cord-blood 25-hydroxyvitamin D levels and risk of early-onset neonatal sepsis: a case-control study from a tertiary care center in Turkey.
Cizmeci MN1, Kanburoglu MK, Akelma AZ, Ayyildiz A, Kutukoglu I, Malli DD, Tatli MM.
Vitamin D has been linked with immunity, and the immunomodulatory role of this molecule in regulating key elements of the immune system has become an area of intense scientific investigation. We designed a case-control study to investigate whether neonates with early-onset neonatal sepsis (EONS) had lower levels of vitamin D. The primary exposure for the analysis in the study was the cord-blood level of 25-hydroxyvitamin D (25(OH)D). Of the 2571 live births occurring during the 18-month study period, 53 infants were admitted to the neonatal intensive care unit with suspected EONS. After clinical and laboratory confirmation, 40 newborns with EONS and 43 controls were analyzed. Cord-blood 25(OH)D levels of infants in the study group were significantly lower than that of the control group (median 12.6 ng/mL (3.1-78.9) vs. 21 (5-118); p = 0.038, respectively). In multivariate models, a low cord-blood 25(OH)D level (<30 ng/ml) was associated with an increased risk of EONS (OR = 5.6; 95% CI = 1.3-23.5).
Cord-blood 25(OH)D levels of neonates with EONS were significantly lower than that of the healthy controls, and a low level of cord-blood vitamin D was found to be associated with an increased risk of EONS. Further studies are warranted to confirm this association.
Sepsis treated with Intravenous Vitamin C, Thiamine, and hydrocortisone - March 2017
- "The global burden of sepsis is estimated as 15 to 19 million cases annually with a mortality rate approaching 60% in low income countries."
- "The hospital mortality was 8.5% (4 of 47) in the treatment group compared to 40.4% (19 of 47) in the control group"
from study: Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study - Dec 2016
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They injected all Sepsis patients for 6 months and compared results from previous 6 months
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