Mark thought he had flu — but his body was un­der at­tack from deadly sep­sis

Daily Mail - - Good Health - By LUCY ELKINS

Hav­ing spent night and day at her hus­band Mark’s bed­side for three months, Diane Sol­lis had al­most given up hope. When­ever she spoke to him, the con­ver­sa­tion was one-sided: Mark was in a med­i­cally in­duced coma and even as he was slowly brought back to full con­scious­ness, he still couldn’t speak or even move very much.

Then fi­nally came the morn­ing when she asked Mark, 54, how he felt and he croaked out the words: ‘not good.’

‘i can’t de­scribe how won­der­ful it was to hear his voice again — my hus­band was back,’ says Diane, 51, who works in sales for a pho­to­graphic com­pany and lives in Tam­worth, Staffs. ‘At that mo­ment, i felt we were so lucky.’

A three-month vigil as her des­per­ately ill hus­band wasted away in hos­pi­tal (at 6 ft 1 in, his weight dropped to 6 st), might not sound like luck. Yet Diane knows how close she was to be­com­ing a widow, left to raise their two teenage chil­dren alone.

Mark had sur­vived sep­sis, an of­ten fa­tal con­di­tion that is es­sen­tially a mas­sive over-re­ac­tion to an in­fec­tion — the body re­leases a flood of chem­i­cals called cy­tokines, which cause blood ves­sels to widen, lead­ing to a dra­matic re­duc­tion in blood pres­sure. Cy­tokines also cause wide­spread in­flam­ma­tion and blood clots that starve vi­tal or­gans of oxy­gen.

Ul­ti­mately, this can lead to or­gan fail­ure and sep­tic shock (when the or­gans and tis­sue are starved of oxy­gen). The in­fec­tion that trig­gers it can be some­thing se­ri­ous, such as pneu­mo­nia, or as in­nocu­ous as a den­tal ab­scess or cut on a fin­ger.

‘it can also fol­low on from flu,’ says Dr Ron Daniels, a con­sul­tant in crit­i­cal care at the Heart of Eng­land NHS Foun­da­tion Trust and chief ex­ec­u­tive of­fi­cer of the char­ity the UK Sep­sis Trust.

Sep­sis can strike at any age and can be ex­tremely dan­ger­ous: it ac­counts for more deaths than breast, bowel and prostate cancer com­bined each year. And yet the con­di­tion is treat­able if it is spot­ted early enough.

Last week a damn­ing au­dit from the na­tional Con­fi­den­tial En­quiry into Pa­tient Out­come and Death (NCEPOD), a body that re­views stan­dards in med­i­cal and sur­gi­cal care, re­ported that at least 37,000 peo­ple a year die from sep­sis — and 150,000 de­velop it — though the report au­thors ad­mit this fig­ure is an un­der­es­ti­mate.

DR DANIELS says the true num­ber of deaths could be as many as 50,000 per year. ‘ The big­gest prob­lem we iden­ti­fied is that doc­tors are not recog­nis­ing it quickly enough,’ says Dr vivek Sri­vas­tava, a con­sul­tant in acute medicine at King’s Col­lege Hos­pi­tal in Lon­don and one of the au­thors of the report.

This may be be­cause ini­tial symp­toms are of­ten put down to other con­di­tions. it is of­ten mis­di­ag­nosed as pneu­mo­nia.

Another prob­lem is that pa­tients de­lay seek­ing help. ‘ The vast ma­jor­ity of us don’t like to make a fuss,’ says Dr Daniels.

‘in 59 per cent of cases in the new report, it was felt that sep­sis pa­tients were not get­ting to hos­pi­tal soon enough, and that was be­cause the per­son did not seek med­i­cal help.’

When he be­came ill, Mark Sol­lis, an IT man­ager, was cer­tain he had flu. That’s what his GP had told him when he went along af­ter three days of cough­ing, aching mus­cles and feel­ing lethar­gic.

Yet rather than get­ting bet­ter af­ter rest­ing at home, he be­came weaker and more breath­less. A week af­ter he fell ill, a con­cerned Diane took him to A&E.

Doc­tors ini­tially di­ag­nosed pneu­mo­nia, but quickly re­alised what the real prob­lem was. Mark was rushed to in­ten­sive care and put on drips with an­tibi­otics and flu­ids.

Sub­se­quent tests found he had pneu­mo­nia caused by le­gionella (a bac­te­rial in­fec­tion that in the early stages can cause flu-like symp­toms), which had prob­a­bly trig­gered the sep­sis.

‘it was hor­ren­dous,’ says Diane. ‘it all hap­pened so quickly — Mark had not had a day off sick in 20 years yet was sud­denly fight­ing for his life. And he was fac­ing an ill­ness i knew noth­ing about — i hadn’t heard of sep­sis be­fore.’

Mark was lucky to be in hos­pi­tal where a team who rou­tinely con­sider sep­sis as a pos­si­ble di­ag­no­sis could treat it quickly. How quickly sep­sis can take hold and de­velop into life-threat­en­ing sep­tic shock and or­gan fail­ure varies from per­son to per­son.

‘it can take 12, 24, 28 hours or more or less — it is un­pre­dictable,’ says Dr Daniels.

Di­ag­no­sis is not straight­for­ward as there is no sin­gle test. Com­mon symp­toms in­clude fever, slurred speech, ex­treme mus­cle pain, pass­ing no urine for 12 hours, se­vere breath­less­ness and mot­tled skin. Many pa­tients report feel­ing as if they are go­ing to die. But not ev­ery­one has the same symp­toms.

‘The symp­toms are so var­ied they can cover an en­tire sheet of A4 pa­per,’ says Dr Sri­vas­tava.

Yet there are ba­sic checks that can alert a medic to sep­sis. ‘ if some­one has a raised pulse, fall­ing blood pres­sure and an in­fec­tion is sus­pected, there needs to be a cul­tural shift so peo­ple think of this as sep­sis and re­act ac­cord­ingly,’ says Dr Sri­vas­tava.

The NCEPOD au­dit was col­lated in part by study­ing the ex­pe­ri­ences of 551 pa­tients. They found that of those who had first vis­ited the GP, only 15 to 30 per cent had the ba­sic checks.

But in A&E, 90 per cent of pa­tients had the checks. And am­bu­lance staff — who can help alert a hos­pi­tal that they have a sep­sis pa­tient — car­ried out these checks in 88 per cent of cases.

ANOTHER ma­jor prob­lem is that the gold stan­dard of care for sep­sis — known as the sep­sis six — is not be­ing ad­hered to.

This is a list of di­ag­nos­tic and treat­ment pro­ce­dures de­vel­oped by Dr Daniels and oth­ers in 2006 that if car­ried out within hours of sep­sis be­ing sus­pected re­duce the risk of death by al­most half.

The sep­sis six in­cludes blood tests, ad­min­is­ter­ing oxy­gen and an­tibi­otics, giv­ing in­tra­venous fluid to im­prove blood pres­sure and mea­sur­ing urine pro­duc­tion.

‘if some­one has gone into sep­tic shock, we know that for ev­ery hour’s de­lay in giv­ing an­tibi­otics, the risk of death in­creases by 8 per cent,’ says Dr Sri­vas­tava.

The sep­sis six has been adopted by 94 per cent of NHS hos­pi­tals. But the new report found that 37 per cent of pa­tients’ treat­ment should have started sooner than it did.

Dr Daniels thinks hos­pi­tal trusts need to take the threat of sep­sis more se­ri­ously if death rates are to fall: ‘ We need a sep­sis cham­pion who over­sees the is­sue in each hos­pi­tal to en­sure high pri­or­ity is given to it.’

Mark and Diane are thank­ful good Hope hos­pi­tal in Birm­ing­ham spot­ted the on­set of sep­sis within hours of his ar­rival in 2008.

‘if i had gone some­where else, there’s a good chance i would not be hav­ing this con­ver­sa­tion,’ says Mark.

sep­sistrust.org

Pic­ture: JOHN LAWRENCE

Bat­tle for life: A re­cov­ered Mark Sol­lis and his wife Diane

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