The word Sepsis has its origin from the Greek word [σήψη], which means putrefaction. In sepsis, the pathogen-associated molecular pattern (PAMP)-pattern recognition receptor (PRR) and damage associated molecular pattern (DAMP)-PRR signaling pathways are activated due to the inflammation and an excess of reactive oxygen and nitrogen species. In the high income countries the mortality of septic shock is 28%-50%, since the diagnosis of the disease and the management of the protocol are poor. Also, approximately 20% of all deaths globally are caused by sepsis. Every year in the United States around 1.7 million sepsis cases and 270,000 sepsis-related deaths are reported (Evans, 2018; Choudhary, 2022).

Surprisingly, men have higher incidence of severe sepsis but the mortality is mixed between the 2 genders maybe because of the sex hormones on innate and adaptive immunity and on the cardiovascular response to cytokine signaling. Also, race is an important risk factor, for example in the US the incidence is higher in African Americans. Another risk factor is the age, since older people have more likely comorbid conditions and patients with sepsis who were aged 65 or more were 2.3 times more likely to die. Conditions that suppress innate and adaptive immunity are risk factors for sepsis, for instance cancer and other chronic conditions such as AIDS/HIV(Gotts and Matthay, 2016).

Thus, the detection of sepsis and the prompt treatment is important. Traditional methods which have been used for the detection of sepsis are serum analysis and molecular methods. Since, there are vague signs and symptoms, the diagnosis of sepsis is more difficult and therefore there is no gold standard test that can confirm the diagnosis. To identify infectious bacteria, the necessary method is the blood culture. In combination with the previous method, molecular approaches such as polymerase chain reaction (PCR), and microarrays techniques are used to detect infection-causing microorganisms, each with varying sensitivity and specificity. Last but not least, hemodynamic stabilization, infection control, and regulation of septic reactions are the 3 elements of sepsis care. Although broad-spectrum antibiotics are essential in the treatment of sepsis, a drawback of antibiotic therapy in sepsis is pathogen resistance, which has a negative impact on sepsis outcomes and doubles fatality rates (Choudhary, 2022). 

Figure 1. Sepsis-3/Septic shock/Sepsis diagnosis. Euler diagram of all intensive care unit (ICU) patients fulfilling the Sepsis-3 and septic shock criteria on admission and those who had sepsis as the main diagnosis at ICU discharge in Sweden (Lengquist et al., 2020).

References

Choudhary, R. (2022) ‘Sepsis Management, Controversies, and Advancement in Nanotechnology: A Systematic Review’, Cureus, 14(2), pp. 1–15. doi: 10.7759/cureus.22112.

Evans, T. (2018) ‘Diagnosis and management of sepsis’, Clinical Medicine, pp. 146–149.

Gotts, J. E. and Matthay, M. A. (2016) ‘Sepsis: Pathophysiology and clinical management’, BMJ (Online), 353. doi: 10.1136/bmj.i1585.

Lengquist, M. et al. (2020) ‘Sepsis is underreported in Swedish intensive care units: A retrospective observational multicentre study’, Acta Anaesthesiologica Scandinavica, 64(8), pp. 1167–1176. doi: 10.1111/aas.13647.

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