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