Claire Dawson
Sepsis is a life-threatening medical emergency caused by the body's overwhelming response to an infection. It is estimated that there are 1.7 million adult sepsis cases in the US each year, with nearly 270,000 deaths. Due to the high mortality rate, it is important to be alert for early signs of sepsis, which include a source of infection (cough, sore throat, abdominal pain, pain with urination) and fevers. There is no single test to diagnose sepsis, but doctors use a combination of tests and clinical signs to make a diagnosis. This guide will cover the various tests used to detect sepsis in a hospital setting.
| Characteristics | Values |
|---|---|
| Symptoms | Cough, sore throat, abdominal pain, pain with urination, fever, low blood pressure, low oxygen delivery to vital organs, organ damage, tissue damage, organ failure |
| Tests | Complete blood count (CBC), blood cultures, blood oxygen level, urine tests, imaging tests, prothrombin time, partial thromboplastin time, platelet count, d-dimer, lactate, C-reactive protein, procalcitonin, liver function tests |
| Treatment | Antibiotics, intravenous fluids, vasopressors, insulin, painkillers, oxygen, dialysis, surgery |
| Prevention | Hand washing, prompt removal of urinary catheters and IV lines |
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Complete blood count (CBC)
A CBC measures how many white blood cells (also called leukocytes) are circulating in the blood, among other things. White blood cells fight bacteria, viruses, and other organisms that the body identifies as dangerous. A higher-than-normal amount of white blood cells in the blood could mean that there is an infection. However, too few white blood cells can indicate a risk of developing an infection. Monocyte distribution width (MDW) can also be measured as part of the CBC. Monocytes are a type of white blood cell that increases in variability when an infection is present.
Basic CBC provides several parameters related to red blood cell characteristics, including hemoglobin (Hb), hematocrit, mean cell (or corpuscular) volume (MCV), mean corpuscular hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), and red distribution width (RDW). Hemoglobin has a critical role in oxygen delivery to the tissues. A decrease in hemoglobin, defined as anemia, is common in patients with sepsis and overall critical illness. It has been estimated that two-thirds of patients admitted to the ICU have hemoglobin levels below the healthy threshold and that 97% of patients develop anemia by day 8 of ICU hospitalization. The measurement of hemoglobin concentration is pivotal for red blood cell transfusion decision-making. However, it is always important to evaluate if the benefits of additional oxygen-carrying capacity outweigh the risks.
Several authors have shown that a rise in red distribution width (RDW) in septic patients is an independent predictor of long- and short-term adverse clinical outcomes, including mortality, especially in the ICU. Additionally, a nomogram based on the combination of CBC parameters, including RDW, has been developed to predict the risk of mortality in patients with sepsis admitted to the emergency department.
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Blood cultures
The process of obtaining blood cultures for sepsis testing involves selecting appropriate body sites for specimen collection, adhering to specified guidelines, and promptly transporting the samples to the laboratory for analysis. Proper specimen management, including collection, transport, storage, and rejection criteria, is vital for optimizing diagnostic accuracy. Clinicians must have a thorough understanding of laboratory requirements through training and easy access to laboratory references.
Additionally, blood culture results can help assess the severity of sepsis. The SOFA (Sequential Organ Failure Assessment) score is used to define sepsis and predict outcomes. It evaluates organ dysfunction in the respiratory, cardiovascular, hepatic, renal, hematologic, and central nervous systems. Higher SOFA scores indicate a higher risk of mortality and the likelihood of requiring intensive care.
It is important to note that blood cultures are just one aspect of sepsis testing in hospitals. Other tests, such as complete blood counts, chemistry panels, and liver function tests, are also performed to evaluate the patient's condition comprehensively.
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Blood oxygen level
One common method to test blood oxygen levels in patients with sepsis is through pulse oximetry. This non-invasive procedure involves clipping a small device called a pulse oximeter to the patient's finger or earlobe. The device uses light to measure the oxygen saturation level of the blood, indicating how effectively the lungs are transferring oxygen into the bloodstream.
Additionally, blood samples may be analysed to assess oxygen saturation levels and immune response. Patients with sepsis can be categorised into two groups based on their blood oxygen saturation levels: those with SaO2 (oxygen saturation) levels less than or equal to 92%, and those with levels greater than 92%. Patients in the former group tend to exhibit a poorer evolution and impaired immune response, with reduced T-cell proliferation.
Furthermore, oxidative stress markers can be evaluated to indirectly gauge the intensity of oxygen release by erythrocytes during oxycytosis and the amount of dissolved oxygen in the blood plasma. This involves detecting oxidants, measuring levels of antioxidants and oxidation products, and assessing the redox balance.
Monitoring blood oxygen levels is essential for sepsis diagnosis and treatment. Low blood oxygen levels in sepsis patients may necessitate oxygen therapy, which can be administered through a mask or nasal tubes to improve oxygen saturation and support the patient's respiratory function.
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Urine tests
Sepsis is a life-threatening medical emergency caused by a dangerous reaction of the immune system to an infection. It causes extensive inflammation throughout the body, which can lead to tissue damage, organ failure, and even death. As there is no single test for sepsis, doctors rely on a combination of tests and clinical signs to diagnose the condition. Urine tests are one of the tools used to detect sepsis.
Urine culture is another test that can be performed to identify the presence of an infection. In addition to urine cultures, bacterial and viral specimens may be evaluated as part of the initial management of suspected sepsis. These tests help identify any new or worsening organ dysfunction in patients with confirmed or suspected infections.
The presence of certain markers in the urine can indicate that the immune system has gone into an over-reactive mode, which is a characteristic of sepsis. Urinary issues, such as reduced urination or an increased urge to urinate, are also common symptoms of sepsis.
Prompt diagnosis and treatment of sepsis are crucial for improving patient outcomes. Urine tests play a vital role in the early detection of sepsis, helping healthcare providers identify potential urinary tract infections and kidney problems that may be associated with this life-threatening condition.
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Imaging tests
X-rays
X-rays can show infections in the lungs and are often used as the first port of call for imaging tests. They can also be used to show infections in the gallbladder and kidneys.
Ultrasound
Ultrasound machines use sound waves to produce real-time images on a video screen. They can show infections in the gallbladder and kidneys.
Computerized Tomography (CT) Scans
CT scans take X-rays from a variety of angles and combine them to show cross-sectional slices of the inside of the body. They are particularly useful for viewing infections in the liver, pancreas, or other abdominal organs.
Magnetic Resonance Imaging (MRI)
MRI machines use radio waves and a strong magnet to produce cross-sectional or 3D images. They are useful for viewing soft tissue or bone infections and can check for swelling or inflammation in the head.
IntelliSep
IntelliSep is an in vitro diagnostic test that uses ultra-high-resolution imaging to capture images of cells. The images are then analysed using machine learning to produce a score reflecting the probability of sepsis.
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Frequently asked questions
Sepsis is a dangerous and extreme reaction to an infection that can lead to organ failure, tissue damage, and death. It is caused by an overwhelming immune response to an infection in the body.
There is no single test for sepsis. Doctors use a combination of tests and symptoms to diagnose sepsis. These include blood tests, urine tests, and imaging tests such as X-rays or CT scans. Blood tests can include complete blood count (CBC), blood cultures, and tests for abnormal liver and kidney function. Urine tests can provide information about urinary tract infections (UTIs) or kidney problems.
The most common signs include a source of infection (cough, sore throat, abdominal pain, pain with urination) and fever. Other symptoms include low blood pressure, low blood oxygen levels, and organ dysfunction.
Treatments for sepsis include antibiotics, intravenous fluids, vasopressor medications, oxygen support, dialysis, and surgery to remove sources of infection. It is important to begin treatment as soon as possible to improve the chances of recovery.
Sepsis is a leading cause of death, with about 1.7 million adult cases in the US each year and 270,000 deaths.
