Sepsis with Crohn’s or Colitis: Cause and Impact

Life with a chronic condition can bring many challenges. Some, like sepsis, may be life-threatening and require immediate attention.

What is sepsis?

Sepsis is a life-threatening reaction to an infection. It is an extreme, full body response that can lead to serious complications, including tissue damage, organ failure, and death. Sepsis is triggered by an infection that progresses. The initial infection can start anywhere, including the lungs, urinary tract, or gastrointestinal tract, among other locations. Sepsis is most commonly caused by a bacterial infection.1,2

Who is at risk for sepsis?

Although, in theory, anyone could become septic, there are some factors that may increase a person’s risk. These include, but are not limited to:

  • Older age (older than 65 years old)
  • Very young age (under 1 year old)
  • Having a weakened immune system (due to an immune-related condition, like HIV, or as a result of immunosuppressing medications)
  • Certain chronic medical conditions, including cancer, kidney disease, lung disease, and some autoimmune conditions1,2

What are the symptoms of sepsis?

Sepsis can present in a variety of ways, however, some of the most common signs and symptoms include:

  • High heart rate (also called tachycardia)
  • Disorientation or confusion
  • Significant discomfort or pain
  • Fever
  • Shortness of breath
  • Clammy or sweaty skin
  • Shivering or feeling very cold1

How is sepsis related to Crohn’s and ulcerative colitis?

As mentioned, sepsis comes from infection. There are a variety of reasons why a person may be at risk of getting an infection or why they may have a harder time fighting an infection off. In the case of an autoimmune condition, like Crohn’s or ulcerative colitis, there may be a variety of reasons involved at the same time. While Crohn’s and ulcerative colitis do not directly lead to sepsis, there are some indirect reasons why they might increase sepsis risk.

First, when a person has an autoimmune condition, their body has a difficult time determining what is normal and what is a threat. Autoimmune conditions are the result of the body attacking its healthy cells by mistake. A malfunctioning immune system may increase the risk of infection or the ability to fight off an infection that can lead to sepsis. Additionally, some of the medications used to treat Crohn’s and ulcerative colitis may change how the immune system functions or suppress it, further increasing infection and sepsis risk. Also, infection after surgery or while staying in the hospital can both lead to sepsis. Surgery and hospital stays may be common experiences for a person living with Crohn’s or ulcerative colitis.2,3

Impact of sepsis

Severe sepsis and septic shock (sepsis that involves the heart) can lead to death and permanent organ damage in some cases. Depending on how severe a person’s sepsis is, and how much damage has occurred, they may need to stay in the intensive care unit (ICU) until they improve. They may receive intravenous (IV) fluids and antibiotics. If the kidneys or lungs are damaged, they may need dialysis, oxygen therapy, or a breathing machine moving forward. Antibiotic medications may need to be continued for months after sepsis is diagnosed. This can all be costly, both financially and in time spent in the healthcare system.

One recent study found that the average death rate from severe sepsis or septic shock was 26.5 percent, however, this risk increased to 34.9 percent for people with ulcerative colitis. On the other hand, the risk decreased to 19.6 percent for those with Crohn’s disease. Additionally, those with severe sepsis or septic shock who also had ulcerative colitis had a higher risk of having an acute kidney injury and needing mechanical ventilation (a breathing machine) afterward. Conversely, those with Crohn’s disease had a lower risk of having an acute lung injury and needing a breathing machine after sepsis.3

The exact cause for these findings is not understood and may be related to the underlying inflammatory process in each condition, as well as the specific medications used to treat them. While these results suggest that those with ulcerative colitis may experience worse outcomes than the general population when it comes to severe sepsis, much more information is needed to understand this relationship.1-4

Preventing sepsis

The best way to prevent sepsis is to be aware of its signs and seek medical attention immediately if you think you may be septic. Especially if you feel as though you are getting sicker after a recent surgery or have a lingering infection that is not improving or that is worsening. Practicing good hygiene including thorough handwashing, washing fruits and vegetables before eating, avoiding those who are sick, and covering wounds can help reduce infection risk. You can also ask your doctor about your sepsis risk as it relates to your health conditions and medications. They may be able to provide you with specific steps you can take to reduce your risk or information on how to seek help quickly if you think you may be septic.1,2

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