Sepsis is a
life-threatening condition triggered by a systemic infection that causes
your body to overreact and launch an excessive and highly damaging
immune response
Unless promptly
diagnosed and treated, sepsis can rapidly progress to multiple-organ
failure and death. In the U.S., 1.7 million adults develop sepsis each
year, and nearly 270,000 die as a result
According to
the most comprehensive global analysis to date, sepsis is responsible
for 1 in 5 deaths worldwide each year — double that of previous
estimates
Despite its
prevalence, sepsis is frequently overlooked, even by health care
professionals. For this reason, it’s important to familiarize yourself
with its signs and symptoms, and to take immediate action if you suspect
sepsis
Sepsis has been
identified as a major contributor in influenza deaths. Some symptoms of
sepsis also resemble those of influenza, so it’s important to know how
to distinguish the two
Sepsis is a life-threatening condition
triggered by a systemic infection that causes your body to overreact and
launch an excessive and highly damaging immune response. Unless
promptly diagnosed and treated, it can rapidly progress to
multiple-organ failure and death.
A number of studies have shown sepsis is becoming ever more
prevalent, making it imperative to be on the lookout for its signs and
symptoms whenever you're ill or in the hospital.
This includes cases of suspected influenza, as sepsis can mimic many
of the signs and symptoms of the flu. In fact, sepsis is one of the
leading causes for influenza deaths. Studies have also identified sepsis as a top cause of death in hospitals, and one of the primary causes of serious harm due to misdiagnosis. Findings show that:
In the U.S., 1.7 million adults develop sepsis each year, and nearly 270,000 die as a result.1
Between 34.7% and 55.9% of American patients who died in hospitals between 2010 and 2012 had sepsis at the time of their death.2
The death rate of in-hospital patients with sepsis is 10% compared to 1% among patients without sepsis.3
Spending for sepsis rose by 19% from 2011 to 2013.4 It is now the most expensive condition treated in the U.S., costing $23.6 billion annually.5,6
Sepsis Responsible for One-Fifth of Global Deaths
Now, the most comprehensive global analysis7,8
done to date warns that sepsis is responsible for 1 in 5 deaths
worldwide each year. The researchers call the finding "alarming," as
their updated figures are double that of previous estimates. As reported
by NPR:9
"They estimate that about 11 million people worldwide died with
sepsis in 2017 alone — out of 56 million total deaths. That's about 20%
of all deaths. 'It's a massive number,' [lead author Dr. Kristina] Rudd
says."
An estimated 85% of these sepsis-related deaths occur in low- to middle-income countries.10 Surprisingly, the paper,11
"A Global Accounting of Sepsis," published in the January 18, 2020,
issue of The Lancet, suggests the rate of sepsis has actually declined
by about half since 1990. NPR reports:12
"That's a surprising finding, says Dr. Chanu Rhee, who studies
sepsis and infectious disease at Harvard Medical School. 'It's really
interesting that in their study, they actually found the incidence of
sepsis declined over the study period,' he says, 'where other studies
have actually suggested the opposite.'"
The authors of The Lancet study do point out that their findings
"must be viewed in context with the constraints of the analysis," as
"modelling assumptions and imputation steps can introduce bias." They
explain:13
"The model inputs to estimate the burden of sepsis for 195
countries came from the vital records of four countries (Brazil, Mexico,
Taiwan, and the USA), and data for hospital case-fatalities were
obtained from ten countries (Austria, Brazil, Canada, Chile, Georgia,
Italy, Mexico, New Zealand, Philippines, and the USA), resulting in
extrapolation from countries of high and middle incomes to low-income
countries.
Because some continents (notably Africa) are not represented as
original sepsis data sources, longitudinal trends might be unreliable.
Hypothetically, improvements in Brazil as a primary data source country
could create the appearance of benefits for sub-Saharan Africa,
irrespective of actual local changes."
A significant hurdle when studying sepsis is the fact that many
doctors overlook it as a contributing cause of death, and don't list it
on the death certificate. Rhee, who has investigated the sepsis burden
in the U.S., tells NPR that — based on his own findings of U.S. death
certificates — sepsis may actually play a role in more than 20% of
deaths worldwide,14 considering most sepsis deaths occur in countries lacking the medical care available in more affluent nations.
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Signs and Symptoms of Sepsis
Despite its prevalence, sepsis is frequently overlooked, even by
health care professionals. For this reason, it's really important to
familiarize yourself with the signs and symptoms of sepsis, and to take
immediate action if you suspect sepsis.
Also inform the medical staff of your suspicion, as time is of the
essence when it comes to treatment. Hydration is of utmost importance,
as much of the damage caused by sepsis begins with the loss of fluids.
While the signs can be subtle at first, sepsis typically produces the following signs and symptoms:15,16,17
Many of these symptoms may be confused with a bad cold or the flu.
However, they tend to develop quicker than you would normally expect.
The Sepsis Alliance recommends using the acronym TIME to remember some of the more common symptoms:18
T — Temperature higher or lower than normal?
I — Have you now or recently had any signs of an infection?
M — Are there any changes in mental status, such as confusion or excessive sleepiness?
E — Are you experiencing any extreme pain or illness; do you have a "feeling you may die?"
Another acronym you could use to memorize the signs and symptoms is SEPSIS, described in the video above:
S — Shivering (fever, cold)
E — Extreme pain
P — Pale, clammy skin
S — Shortness of breath
I — "I feel like I might die"
S — Sleepy (confused)
Beware: Sepsis Plays a Role in Many Influenza Deaths
Importantly, sepsis has been identified as a major contributor in influenza deaths.
According to researchers, "Severe sepsis is traditionally associated
with bacterial diseases … However, viruses are becoming a growing cause
of severe sepsis worldwide."
As noted in the video above, some sepsis symptoms also resemble those
of influenza, which can have tragic consequences if you do not seek
medical help in time. The video offers guidelines on how to tell the
difference between the two.
Sepsis, without doubt, requires immediate medical attention, whereas
most people will successfully recover from flu with a few days to a week
of bedrest and fluids. Just how influenza can lead to sepsis is a
somewhat complex affair, described as follows:19
"In the initial response to an infection, severe sepsis is
characterized by a pro-inflammatory state, while a progression to an
anti-inflammatory state develops and favors secondary infections …
In the predominant pro-inflammatory state, Th1 cells activated by
microorganisms increase transcription of pro-inflammatory cytokines such
as tumor necrosis factor (TNF-α), interferon-γ (INF-γ), and
interleukin-2 (IL-2).
[C]ytokines … released from endothelial cells and subsequently from
macrophages can induce lymphocyte activation and infiltration at the
sites of infection and will exert direct antiviral effects.
Subsequently, with the shift toward an anti-inflammatory state,
activated Th2 cells secrete interleukin-4 (IL-4) and interleukin-10
(IL-10).
In certain situations, T cells can become anergic, failing to
proliferate and produce cytokines. Type I IFN has a potent
anti-influenza virus activity; it induces transcription of several
interferon stimulated genes, which in turn restrict viral replication.
However, influenza virus developed several mechanisms to evade IFN
response … Viral infections such as the influenza virus can also trigger
deregulation of the innate immune system with excessive cytokines
release and potential harmful consequences.
An abnormal immune response to influenza can lead to endothelial
damage … deregulation of coagulation, and the consequent alteration of
microvascular permeability, tissue edema, and shock."
Remember to Ask for This Life-Saving Sepsis Protocol
If you or a loved one succumbs to sepsis, whether caused by influenza
or some other infection, please remember that a protocol of IV vitamin C
with hydrocortisone and thiamine (vitamin B1) can be lifesaving,20 so urge your doctor to use it. Chances are, they might not even be aware of it.
This sepsis treatment protocol
was developed Dr. Paul Marik, a critical care doctor at Sentara Norfolk
General Hospital in East Virginia, and clinical use has proven it to be
remarkably effective for the treatment of sepsis, reducing mortality
nearly fivefold.
Marik's retrospective before-after clinical study21,22
showed that giving patients IV vitamin C with hydrocortisone and
vitamin B1 for two days reduced mortality from 40% to 8.5%. Of the 50
patients treated, only four died, and all of them died from their
underlying disease, not sepsis.
The precise protocol used was 200 mg of thiamine every 12 hours,
1,500 mg of ascorbic acid every six hours, and 50 mg of hydrocortisone
every six hours.23
Importantly, the treatment has no side effects and is inexpensive,
readily available and simple to administer, so you really have nothing
to lose by trying it.
Sentara Norfolk General Hospital, where Marik works, has made the
protocol its standard of care for sepsis, and other hospitals are also
starting to follow suit. Unfortunately, many are still dragging their
heels, waiting for the completion of additional clinical trials.
According to Marik, vitamin C and corticosteroids have a synergistic effect,24
which is part of why his combo protocol is so effective. Still, simply
using high-dose IV vitamin C exclusively has been shown to improve
survival in patients with sepsis and acute respiratory failure, reducing
mortality from 46% to 30%.25
It also reduced the number of days they needed to remain
hospitalized. On average, those who received vitamin C had by day 28
spent three fewer days in the intensive care unit than the placebo group
(seven days compared to 10). By day 60, the treatment group had also
spent seven fewer days in the hospital overall —15 days compared to 22.26
While there are no trials that look at integrating hyperbaric oxygen
therapy, my strong suspicion is that this would be a powerful synergy
that could get the fatality rate from the problem far closer to zero.
Sadly, this treatment is not available at many hospitals, and even if it
were, it is not approved for this indication.
Educational Resources for Your Doctor
Marik's sepsis protocol can be a lifesaver, so you'd be wise to
discuss it with your doctor any time you're hospitalized. Remember,
sepsis is often the result of a secondary infection contracted while in
the hospital, so it's prudent to be prepared.
This way, should you develop sepsis while you're admitted, your
medical team already knows your wishes and can act swiftly. According to
Marik, the best results are obtained when the concoction is
administered within the first six hours of presentation of symptoms.27 The longer you delay treatment, the less likely it will be successful.
You can learn more about Marik's sepsis protocol in "Vitamin C — A Game Changer in Treatment of Deadly Sepsis,"
along with commonsense recommendations for how to lower your risk of
sepsis in the first place. You can also review Marik's PowerPoint
presentation, "Hydrocortisone, Ascorbic Acid and Thiamine for the Treatment of Severe Sepsis and Septic Shock," presented at the 2020 Critical Care Reviews meeting in Australia.
If your doctor refuses to consider it offhand, convince him or her to review the studies cited here.28,29,30,31,32,33,34,35,36,37 Simply look up the references 27 through 36 and make copies to take to your doctor. Alternatively, you can go to PubMed38 directly and type in "vitamin C" and "sepsis" in the search engine and you will get a list of the available research.
While there are certain situations in which the hospital may still
deny this treatment, if you are an adult who is sick, you will usually
have the right to insist on it. I will actually be interviewing Marik
shortly and hope to work with him on developing a process to make it
easier for patients to implement this strategy in their local hospital.
In most cases, you'd probably just need to sign an "Against Medical
Advice — Acknowledgment and Waiver" form (samples of which can be found
in the references39), which states you've elected to not follow the standard of care recommended by your doctor.
Contraindication for IV Vitamin C Treatment
The only contraindication is if you are glucose-6-phosphate dehydrogenase (G6PD) deficient (a genetic disorder).40
G6PD is required for your body to produce NADPH, which is a cousin of
NAD+ and necessary to transfer reductive potential to keep your
antioxidants, like glutathione and vitamin C, functional.
Because your red blood cells do not contain any mitochondria, the
only way it can provide reduced glutathione is through NADPH, and since
G6PD eliminates this, it causes red blood cells to rupture due to
inability to compensate for oxidative stress.
Fortunately, G6PC deficiency is relatively uncommon, and can be
tested for. People of Mediterranean and African decent are at greater
risk of being G6PC deficient. Worldwide, G6PD deficiency is thought to
affect 400 million individuals, and in the U.S., an estimated 1 in 10
African-American males have it.41
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