7 Warning Signs of Sepsis

This life-threatening disease can be difficult to diagnose, but early treatment is crucial

Sepsis, bacteria in blood. 3D illustration showing rod-shaped bacteria with red blood cells and leukocytes

Dr_Microbe/Getty Images

Michelle Crouch,

AARP

En español

Published February 24, 2023

Usually you feel better after you pass a kidney stone. But not long after Timothy Gibbons passed one in December 2022, he woke up one morning with shivers, nausea and terrible pain when he tried to urinate.

Gibbons, 53, a funeral director in Fairview Heights, Ill., thought he probably had a urinary tract infection. But when his heart started racing and his vision blurred, he realized his condition was serious.

He rushed to the emergency room, where doctors diagnosed him with sepsis.

Sepsis is a life-threatening condition that happens when your body overreacts to an infection. It can be triggered by a urinary tract infection, a lung infection or even an infected cut or scrape.

Vaccines lower sepsis risk

Experts say one of the best ways to protect against sepsis is to get all recommended vaccines, including your annual flu, COVID-19 and pneumococcal shots. They can help protect you from infections that lead to sepsis.

More than 1.7 million American adults every year develop sepsis, and as many as 30 percent of them die from the illness.

Older adults are particularly susceptible.

“When they said, ‘You have sepsis,’ I thought I was about to die,” Gibbons says. “As a funeral director, I see that on death certificates all the time.”

A “sneaky” illness

In sepsis, the body’s response to an infection is out of control, creating inflammation and setting off a cascade of problems. Blood pressure drops and blood vessels get leaky, impeding blood flow to important organs such as the heart and brain. “Most of the time when we develop an infection, we can keep it localized where it started. But there are times when the body can’t do that. That’s really what sepsis is,” says Grant O’Keefe, a physician at the University of Washington School of Medicine who has studied sepsis in trauma patients.

Sepsis can be triggered by any type of bacterial or viral infection.

The infection often starts in the lungs, urinary tract, skin or gastrointestinal tract, according to the Centers for Disease Control and Prevention (CDC).

“Particularly in older people, urinary tract infections are a common cause,” says Wesley Self, an emergency medicine physician and senior vice president for clinical research at Vanderbilt University Medical Center. “Lung infections [pneumonia] are also very common.”

Sepsis is treated with antibiotics, fluids and support to vital organs, and early treatment offers the best chance of cure. But sepsis can be hard to detect before someone is seriously ill.

Patients “may not always have clear symptoms,” says Mark Winther, an emergency medicine physician at Bassett Healthcare in Cooperstown, New York. “The reason it’s so dangerous is that it’s sneaky.”

When to suspect sepsis

Adults age 65 and older are 13 times more likely to be hospitalized with sepsis than younger adults, studies show.

If you’ve had any kind of recent infection and you aren’t feeling like yourself, you should ask your health care provider if sepsis could be the cause, doctors said.

You’re at higher risk for sepsis if you have a weakened immune system or a chronic condition such as diabetes, kidney disease or lung disease.

You should also be vigilant if you’ve been in the hospital recently, because some sepsis cases are caused by infections like staph or E. coli you can pick up in a health care setting. A 2020 study published in Intensive Care Medicine found that about 24 percent of sepsis patients had a hospital-acquired infection. It’s also important to be wary at home or in the community, as nearly 87 percent of cases start before a patient goes to the hospital, according to the Centers for Disease Control.

VIDEO: How to Prevent Sepsis

Sepsis warning signs

Because sepsis is hard to detect, seek out medical care if you or a loved one has any of the following symptoms:

1. Extreme pain or discomfort (often at the infection site)

“The way sepsis works, there are often symptoms related to the site of infection within the body,” Self says.

If sepsis is triggered by a gastrointestinal infection, for instance, you may experience severe abdominal pain along with vomiting or diarrhea. Lung infections usually cause shortness of breath and chest pain, while a skin infection can cause a red, warm and painful rash.

2. Lethargy or tiredness

Sleepiness is common in sepsis patients, especially older adults. You may have less energy or just not feel like yourself.

Pay attention if fatigue causes someone you care about to miss a regular activity like going to church, Winther says: “A very common thing I hear is, ‘Mom normally gets up early. I went over there, and she didn’t want to get out of bed.’ ”

3. Confusion or dizziness

Low blood flow to the brain causes some patients with sepsis to feel extremely light-headed or dizzy. Others, especially those in long-term care, may experience a sudden change in mental status, or confusion.

“For patients who live in assisted living and skilled nursing facilities, it can be something as simple as not interacting with caregivers as much as normal,” Self says. “For people who are verbal and usually carry on conversations, it’s usually obvious when someone is saying things that don’t make sense or seem forgetful.”

4. Fever, shivering and chills

A high temperature is the classic sign that your immune system is fighting an infection, and it’s also a common early sign of sepsis. You may also experience shivering or feel very cold.

However, you can’t rule out sepsis just because you don’t have a fever, Winther says. Some adults over age 65 and those with weakened immune systems don’t run a temperature, he says.

5. A very low body temperature

A body temperature under 96 degrees (hypothermia) can also be a sepsis symptom, although it’s not as common. Studies show that hypothermia is associated with a more serious case of sepsis and a higher risk of death.

6. Fast heart rate, fast breathing or breathlessness

When your body is overreacting in sepsis, it needs more oxygen, so your heart and breathing rate rise. Although it can be difficult for patients to detect those symptoms in themselves, a caregiver may notice fast breathing, Self says.

7. Clammy, sweaty or blotchy skin

With blood being diverted away from the skin to important organs, your skin may feel clammy and look pale, blue or blotchy. On darker skin, blueness may be easier to see on the palms of the hands or the soles of the feet.

Some people with sepsis develop a cluster of tiny blood spots that look like pinpricks in the skin. If untreated, these gradually get bigger and begin to look like bruises.

The good news is, many hospitals now have protocols or systems to help doctors recognize the signs of sepsis, and sepsis death rates have dropped.

Gibbons said his doctors in the ER suspected sepsis right away. He ultimately spent six days in the hospital, getting antibiotics and fluids intravenously. The lesson, he says, is to seek treatment when you know something isn’t right. “My doctor told me if I had not come in when I did, this might be a different story. It might be my obituary,” he said.

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Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation’s top consumer publications. Her work has appeared in Reader’s Digest, Real Simple, Prevention, The Washington Post and The New York Times.