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What Are the 3 Stages of Sepsis

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Candida Auris fungi, emerging multidrug resistant fungus, 3D illustration

The three stages of sepsis – sepsis, severe sepsis, and septic shock, may cause serious illness or death. Sepsis affects approximately 1.7 million people across the U.S. in an average year, according to the Centers for Disease Control and Prevention. Of those who develop sepsis, 350,000 or more are discharged to hospice or die during their hospitalizations.

Candida Auris fungi, emerging multidrug resistant fungus, 3D illustration

What Is Sepsis?

Sepsis is the term used to refer to a life-threatening inflammatory response. It occurs as a result of an infection, typically starting in the lungs, gastrointestinal tract, urinary tract, or skin. In some people, infections can set off this type of chain reaction, which may ultimately result in tissue damage or organ failure, or even death.

Sepsis is categorized into one of three stages – sepsis, severe sepsis, and septic shock. The stage depends on the resulting effects and how far progressed the response is.

Stage One

Patients are diagnosed with stage one sepsis when they first begin to exhibit signs and symptoms of an overreaction to an infection. To be diagnosed with sepsis, patients must exhibit at least two early symptoms of the condition. The early symptoms of sepsis include a temperature of above 101 °F or below 96.8 °F, a confirmed infection, breathing at a rate of more than 20 breaths per minute, or having a heart rate over 90 beats per minute.

Those diagnosed with stage one sepsis will not yet have started to experience organ function problems commonly caused by the inflammation and low blood pressure. With early diagnosis and appropriate care, patients diagnosed with sepsis typically make full recoveries.

Stage Two

Stage two sepsis, also known as severe sepsis, occurs when organ damage results from the body’s reaction to an infection. Such dysfunction may affect any internal organs. Most commonly, the dysfunction that leads to a severe sepsis diagnosis manifests in the respiratory and cardiovascular systems.

Doctors may diagnose patients with severe sepsis who display at least one of the following symptoms or signs:

  • Decreased urine output
  • Chills resulting from a drop in the body’s temperature
  • Unusual or unexplained pain
  • Extreme weakness
  • Abnormal heartbeat
  • Breathing difficulties

In addition to these symptoms, severe sepsis may also cause people to experience unconsciousness, confusion, or other sudden changes in their mental states. For example, older adults, in particular, may exhibit agitation or irritation. 

For many who receive a timely diagnosis of their conditions, mild sepsis resolves with appropriate treatment and care. 

Stage Three

Stage three sepsis, or septic shock, is the most severe stage of this condition. Patients are diagnosed with septic shock when they have suffered organ damage as a result of the body’s inflammatory response. As the body continues to have this overwhelmed response, blood flow is often significantly impaired and vital organs may not receive an adequate supply. Due to a lack of blood flow, these organs may begin shutting down. 

At this stage, patients will continue to exhibit signs and symptoms of sepsis, despite treatments such as IV fluids and medications. Additionally, many will have elevated serum lactate levels. The body produces the chemical lactate when it becomes stressed to fuel the cells. 

The most dangerous stage of sepsis, septic shock, often has an unfavorable prognosis. The mortality rate for those with septic shock is between 30% to 40%.

Diagnosing the 3 Stages of Sepsis

No specific diagnostic test yet exists for sepsis. However, physicians can use a combination of physical examination of the patient’s clinical signs and other testing to diagnose this condition. 

Often, these diagnostic laboratory and imaging tests are aimed at confirming a patient has an underlying infection and to identify the type of infection. Additionally, doctors will review the symptoms from which a patient currently suffers, as well as his or her medical history to look for potential risk factors for sepsis.

Doctors commonly order blood tests to check for higher or lower than normal white blood cell levels. When white blood cell counts are elevated, it indicates the patient currently has an infection. If the count is too low, it can indicate that the patient may be at risk of developing an infection.

Laboratory testing for lactic acid levels also help doctors pinpoint whether a patient has sepsis. High levels of lactic acid can sometimes be a sign of an infection. Muscles and organs release lactic acid when they aren’t receiving adequate oxygen.

Other blood tests may look for enzymes, which will show how the liver is functioning, and creatine levels to assess kidney function. Doctors may also order lab testing to look for cardiac biomarkers, which are substances the body releases when the heart becomes stressed or damaged.

Imaging tests are also used to help diagnose the stages of sepsis. X-rays, ultrasound, CT scans, and MRIs may show infections in some vital organs, soft tissues, or bones.

Treating the 3 Stages of Sepsis

Treatment of sepsis will involve addressing the underlying infection, as well as the symptoms resulting from this inflammatory response. Patients with one of the three stages of sepsis will typically receive antibiotic treatment to target the bacteria, virus, or fungus causing the infection. They may also receive medications such as pain relievers and insulin to regulate their blood sugar levels.

To help hydrate the body, and to regulate its temperature and functions, patients with sepsis also commonly receive intravenous fluids. Doctors also sometimes use vasopressors to help increase a patient’s blood pressure if IV fluids do not help raise it to a safer level. These types of medications work by narrowing the blood vessels.

Depending on the septic stage and symptoms they’re experiencing, patients may also need supportive care, such as dialysis to aid with kidney function or oxygen machines to help them breathe. 

Long-Term Complications from Sepsis

Sepsis is a serious illness that requires time for recovery. In addition to an extended hospitalization, those who have had this condition often need time to settle back in and get back to their full health. In the short-term, people may have general aches and pains, difficulty moving around, hair loss, brittle nails, breathlessness, and weakness or fatigue. Some may also experience a lack of appetite, food tasting different, or weight loss.

Many post-sepsis effects resolve with time. Others may not develop until several weeks later, or may continue to progress and plague patients long after their discharge from the hospital. 

People who have recovered may have post-sepsis effects, such as panic attacks, loss of self-esteem, vivid hallucinations, nightmares, or insomnia.

Additionally, as a result of having had sepsis, some may experience long-term organ dysfunction. Disabling joint and muscle pain is also common among people who recover from one of the stages of sepsis.

Most Common Causes of Sepsis

Any type of infection may lead to the onset of sepsis. Often, people who suffer from the stages of sepsis have underlying lung, urinary tract, intestinal, gut, or skin infections. These infections may be viral, bacterial, or fungal. The underlying infections that result in sepsis often involve staphylococcus aureus, E. coli, and some types of streptococcus germs.

Sepsis is not contagious; however, some infections that cause sepsis may be spreadable. Therefore, cautionary steps, such as the prevention of bedsores in nursing homes, practice of good hygiene, and familiarity with the signs of sepsis, can help reduce chances of patients developing this potentially life-threatening condition.

Biggest Risk Factors of Sepsis

Sepsis may affect nearly anyone suffering from an infection. However, some patients have a more substantial risk of experiencing this type of potentially life-threatening inflammatory response. Those who have an increased chance of an infection leading to sepsis include:

  • Infants
  • Adults over the age of 65
  • Patients in the intensive care unit or who otherwise require longer-term hospitalization
  • Patients who require IVs or breathing support
  • People with chronic diseases, including COPD, diabetes, or kidney disease
  • People with lowered immune responses, such as those with AIDS or who are undergoing treatment for cancer

Certain types of medications or medical treatments may also increase the risk of sepsis for some. For example, patients who have had antibiotics or corticosteroids may be more likely to develop sepsis due to an infection. 

Recovering Damages for Healthcare-Caused Sepsis

As a result of developing sepsis, patients may experience wide-ranging financial and emotional losses. For example, they may incur additional medical bills due to the extra care required to treat this condition, suffer lost wages while off of work recovering from their conditions, and experience physical and emotional pain and suffering. 

Who is liable for sepsis in nursing homes? Under certain circumstances, patients who develop sepsis may be able to file a lawsuit against the healthcare professional or facility responsible for causing their conditions. Through such legal actions, they can seek to recover compensatory damages for their resulting economic and non-economic losses. In cases when a patient dies as a result of septic shock, his or her family may have legal grounds to sue a hospital for wrongful death.

Proving Medical Malpractice for Sepsis Cases

To successfully recover compensation in a medical malpractice lawsuit for healthcare-caused sepsis, patients must prove four essential elements – duty of care, violation of the duty of care, causation, and damages. A medical malpractice lawyer may aid victims in gathering the necessary documentation and preparing other evidence to help establish these elements.

Duty of Care

Healthcare professionals have a legal responsibility to exercise the same degree of skill and care that the average medical professional in their areas would use in similar circumstances. By agreeing to treat the patient, and the patient agreeing to receive the provider’s care, the type of relationship needed to make doctors and nurses beholden to this duty is established.

Violation of the Duty of Care

After establishing that the medical provider owed them a duty of care, injured patients in medical malpractice cases must prove that the healthcare professional breached this responsibility. To this end, they may enlist the aid of expert witnesses to testify on their behalf regarding the steps that were or were not taken, and what a reasonable provider would likely have done. Such testimony helps the jury see the steps that should have been taken. Therefore, it helps to highlight the areas of shortcomings where the doctor violated his or her duty of care.

Causation of the Injury

It is not enough for a healthcare provider to violate his or her duty of care. The patient must show that he or she developed one of the stages of sepsis as a direct result of this violation. For example, after having an IV inserted improperly, a patient developed a hospital-acquired infection. As a result of this infection, the patient develops sepsis. The injured patient may argue that the incorrect insertion of the IV directly caused his or her infection, and thus, the onset of sepsis.

Resulting Damages

To recover damages in a medical malpractice claim, injured patients must have suffered losses for which they can be compensated. For instance, this may include additional medical costs for the hospital stay, lost income while off of work recovering, and pain and suffering. 

Providing billing invoices, banking statements, and other such financial documents can help show that patients suffered actual financial losses due to developing sepsis. A diary, as well as testimony from family or friends, can aid in proving less tangible losses, such as loss of enjoyment of life, for which plaintiffs can recover compensation. 

In cases involving medical errors that lead to death, certain family members can pursue compensation for their direct losses due to the loss of their loved one because of the medical mistake and resulting sepsis.

Developing sepsis can be life-threatening for patients. In cases when their conditions were the result of a doctor’s negligence, or were allowed to progress for that reason, they may seek to hold the at-fault provider financially responsible for their resulting losses.

About the Author

Kurt D. Lloyd is a plaintiff’s trial lawyer who focuses on medical malpractice and other catastrophic injury cases. He lives in Chicago and represents injured clients throughout Illinois. He is also the founder of Lloyd Miller Law, Ltd.

Years of Experience: Approx. 20 years
Minnesota Registration Status: Active
Bar & Court Admissions: Illinois State Bar Association U.S. District Court, Northern District of Illinois

Kurt D. Lloyd is a plaintiff’s trial lawyer who focuses on medical malpractice and other catastrophic injury cases. He lives in Chicago and represents injured clients throughout Illinois. He is also the founder of Lloyd Miller Law, Ltd.

Years of Experience: Over 35 years
Illinois Registration Status: Active
Bar Admissions: Illinois State Bar