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Why Is Sepsis a Leading Cause of Death?

Contributor Chanu Rhee, MD, MPH
9 minute read
An older woman in a hospital bed, hooked up to an IV.

Sepsis is a life-threatening medical emergency that happens when the body’s immune response to an infection causes damage to vital organs. According to the Centers for Disease Control and Prevention (CDC), sepsis affects 1.7 million adults in the United States each year and at least 350,000 of those adults die or end up in hospice care. It is the leading cause of death in hospitalized patients and contributes to 1 in every 3 deaths in the hospital. Most cases of sepsis begin in the community, but it can also arise from infections acquired in the hospital.

“Without timely treatment, sepsis can get worse very quickly and lead to organ failure and death,” says Chanu Rhee, MD, MPH, a Mass General Brigham critical care medicine and infectious diseases doctor. Dr. Rhee cares for patients at Brigham and Women’s Hospital.

Dr. Rhee shares information about the signs and symptoms of sepsis, and why it’s essential to get medical care immediately to prevent death.

What causes sepsis?

The immune system’s job is to protect your body from infections. One way the immune system responds to infections is through inflammation, which can produce symptoms like:

  • Redness

  • Heat

  • Pain

  • Swelling

Sometimes inflammation doesn’t cause any noticeable symptoms. In a typical infection, the inflammation eventually calms down as your body recovers.

In sepsis, the body’s inflammatory response to an infection spirals out of control. The inflammation can lead to blood clots, leaky blood vessels, and dangerously low blood pressure, which deprives the body’s organs of oxygen. If not treated quickly enough, sepsis can cause tissue damage, organ failure, and even death.

Bacterial infection and sepsis

Most cases of sepsis are caused by bacterial infections. According to the CDC, infections that cause sepsis most commonly start in the following places in the body:

  • Lungs

  • Urinary tract

  • Skin

  • Gastrointestinal tract

Viral infections and sepsis

Viral infections, like COVID-19 or influenza (the flu), and fungal infections can also cause sepsis.

Is sepsis contagious?

Sepsis itself is not contagious, but some of the infections that lead to sepsis (such as COVID-19 and influenza) can be spread from person to person.

People who have multiple risk factors are generally at higher risk than those who have only one risk factor. However, sepsis can also occasionally affect previously healthy patients, including young adults and even children. It is therefore important for everyone to be aware of the signs and symptoms of sepsis.

Chanu Rhee, MD, MPH
Critical Care and Infectious Diseases Doctor
Mass General Brigham

Who is at risk for sepsis?

Most people who develop sepsis have an underlying medical condition. People who are at a higher risk for sepsis include:

  • Adults 65 years or older

  • Children younger than one

  • People with weakened immune systems

  • People with chronic conditions like diabetes, lung disease, cancer, or kidney disease

  • People with recent severe illness or hospitalization

  • People who have survived a previous episode of sepsis

“People who have multiple risk factors are generally at higher risk than those who have only one risk factor. However, sepsis can also occasionally affect previously healthy patients, including young adults and even children. It is therefore important for everyone to be aware of the signs and symptoms of sepsis,” Dr. Rhee says.

Sepsis symptoms

Signs and symptoms of sepsis include:

  • Racing heart rate or weak pulse

  • Fever, shivering, or feeling very cold

  • Confusion or disorientation

  • Shortness of breath

  • Extreme pain or discomfort

  • Clammy or sweaty skin

According to Dr. Rhee, “These symptoms may also occur with signs of infection at specific body sites,” which can include:

  • Productive cough and difficulty breathing (for lung infections)

  • Redness on the skin or drainage from a wound (for skin infections)

  • Abdominal pain, nausea, and/or vomiting (for gastrointestinal or abdominal infections)

  • Burning on urination (for urinary infections)

Sepsis is a medical emergency. If you’re worried you have sepsis or have an infection that’s not getting better or keeps getting worse, get medical care immediately. The CDC recommends asking your health care provider, “Could this infection be leading to sepsis?” and if you should go to the emergency room.

How is sepsis diagnosed?

“Getting a timely diagnosis of sepsis is crucial. Several studies suggest that the risk of death increases between 4-8% for each hour that treatment is delayed,” says Dr. Rhee.

Because sepsis can be caused by different types of infections, there’s no single test that can make the diagnosis with 100% accuracy. Health care providers diagnose sepsis through a physical exam and other tests, including blood tests, cultures from the blood and other body sites, and sometimes x-rays or other radiologic tests. These tests can reveal if you have organ damage and which infection is causing the sepsis. This helps your care team determine the best medications to treat sepsis. 

How is sepsis treated?

Treatment for sepsis requires medical care in a hospital. The faster treatment begins, the better your outcome. Often, patients receive care in the intensive care unit (ICU). There, health care providers carefully monitor their vital signs like pulse, body temperature, rate of breathing, oxygen levels, and blood pressure. Depending on how severe the sepsis is, treatment can include:

  • Antibiotics, antivirals, or antifungals to treat the infection

  • Intravenous fluids

  • Medications to treat low blood pressure

  • Surgery to remove infected and damaged tissue

  • Dialysis (a treatment for kidney failure)

  • Use of a ventilator, a machine that helps you breathe if you’re having difficulty, or other types of oxygen devices

  • Steroids to reduce inflammation in the body

Sepsis recovery

After recovering from sepsis, you may have long-term side effects including pain and fatigue. In the initial days, you may need assistance with everyday activities like bathing, sitting up, and walking. Care teams sometimes recommend rehabilitation programs, which may include physical therapy exercises. This often starts while you’re still in the hospital. Slowly increase your activity levels, taking plenty of time to rest as you build back their strength.

If you survive sepsis, you’re at higher risk of getting sepsis again. Pay close attention to any symptoms of sepsis and get emergency medical immediately if necessary.

If you find this challenging health experience affects your mental health, you’re not alone. It’s common for people recovering from sepsis to experience anxietydepression, frustration, and confusion.

The physical and mental impacts of sepsis should improve with time, but talk to your primary care provider (PCP) if you have concerns about your recovery.

How to prevent sepsis

To prevent sepsis, “Consult your PCP early when signs and symptoms of infection develop, before the infection progresses to sepsis. This is particularly important for patients who are at a higher risk for sepsis,” notes Dr. Rhee. 

Another way to prevent sepsis is to avoid infections in the first place. Tips to prevent infections and stay healthy include:

  • Practice good hygiene: Wash your hands frequently, clean and cover any cuts with a bandage, and avoid being around people who are sick.

  • Work with your PCP to manage and coordinate care for chronic conditions that could put you at a higher risk for sepsis.

  • Get any health screenings your PCP recommends.

  • Stay up to date on all vaccinations, including the COVID-19 vaccine, the flu vaccine, and the shingles vaccine if you’re eligible.

  • Maintain a healthy lifestyle: Exercise regularly, eat a healthy diet low in cholesterol, and get enough sleep.

  • Limit alcohol and quit smoking. Tell your provider if you need help.

Sepsis research

Researchers including Dr. Rhee are studying ways to improve how sepsis is treated and prevented. “In my own research, we’re trying to better identify the clinical signs of sepsis. Which are the most time-sensitive and require immediate antibiotics to improve patient outcomes? We’re trying to develop better methods to track the incidence and outcomes of sepsis over time and across hospitals. We also want to measure the quality of care that hospitals deliver for patients with sepsis,” he explains.

Other promising areas of sepsis research include:

  • Developing better tests to rapidly diagnose sepsis and the specific infections that lead to sepsis

  • Studying the different types of immune responses in sepsis to develop more targeted treatments

  • Exploring the use of artificial intelligence to better identify sepsis and predict which patients will go on to develop sepsis.

By taking steps to prevent infection, and getting prompt treatment for any concerning symptoms, you can decrease your risk of dying from sepsis.

Chanu Rhee, MD, MPH


Critical Care and Infectious Disease Doctor