The Early Signs of Sepsis: How to Spot This Life-threatening Condition

Sepsis is a life-threatening medical emergency. Early recognition is the key to fast diagnosis, treatment, and survival. But sepsis can be hard to spot in the early stages, even for healthcare providers. 

The early signs can be vague, so many times it’s not obvious until it gets much worse. But if you know the signs and symptoms to look for, you can make sure you or a loved one gets the necessary medical attention. 

What causes sepsis? 

Sepsis is caused by the immune system’s response to an infection. When you’re sick, the immune system launches a defense attack to fight off the infection. This includes immune cells and proteins that aim to kill the unwelcome invader. But this turns the body into a battleground. Sepsis occurs when the immune system starts to damage the body as well. 

Any type of infection can lead to sepsis. Most often it’s a bacterial infection. But viral infections, fungal infections, and parasitic infections can cause sepsis, too. 

What are the risk factors of sepsis? 

Sepsis can happen to anyone, but some people are at higher risk. The risk factors for sepsis include:

• Age: Children less than 2 years old and people older than 65 years old often have weaker immune systems. This makes it easier for infections to travel into the bloodstream, which increases the chances of getting sepsis.

• Weakened immune system: A person’s immune system might be weak from conditions (like cancer or autoimmune disease) or medications (like chemotherapy or immunosuppressants). 

• Chronic conditions: Many long-term conditions can affect the immune system. Examples include diabetes, kidney disease, liver disease, and sickle cell. 

• Chronic infections: Examples of chronic infection include HIV, recurrent urinary tract infections, or open skin wounds that are not healing. 

• Burn/trauma: Broken skin may be a result of trauma or burns. This makes it easier for germs to enter the body and cause a serious infection.

• Indwelling medical devices: These are inserted inside someone’s body. For example, someone might have a port or PICC line to receive chemotherapy or antibiotics. Or someone may have a Foley catheter in their bladder if they have problems with urination. Germs can stick on these devices and enter the body more easily. 

• Recent surgery: The chance of sepsis is higher in a person who recently had surgery for many of the reasons already listed. It often involves a break in the skin, an IV catheter to access the veins, and a urinary catheter.

• Pregnancy: This includes women who are pregnant, have given birth in the past 6 weeks, or who have had a miscarriage or abortion in the past 6 weeks.

• Hospitalization: Being in the hospital increases the chance of getting an infection. And people who are hospitalized for a long time are at increased risk for sepsis for various reasons. They may have chronic conditions that increase their risk. 

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What are the early signs of sepsis? 

It can be hard to spot the earliest signs of sepsis, especially because a lot of the symptoms are the same ones the infection itself causes. But most people have a sense if they — or people they know — are getting worse rather than better. And this instinct can be the first clue that sepsis may be developing on top of the infection.

Some of the first signs of sepsis include:

• Temperature higher than 100.4°F or lower than 96.8°F

• Shivering or feeling cold

• Shortness of breath or breathing faster than normal

• High heart rate (over 100 beats per minute) or a feeling that the heart is racing

• Confusion or trouble thinking clearly

• Fatigue and weakness

It can be even harder to recognize sepsis in the very young and very old. Older adults don’t always display the classic signs of sepsis. Or they may have chronic conditions that mask sepsis symptoms. For example, it may be hard to tell if someone with dementia is more confused than normal. Or someone with chronic lung disease may always feel a little short of breath. 

Babies and young children may also behave a little differently. But it can be hard to pick up on these clues because they can’t clearly communicate how they’re feeling. Early signs of sepsis in the very young may include poor feeding, poor muscle tone, lethargy, or a significant decrease in wet diapers. You may also notice that their skin feels very flushed or clammy, or it may have a blotchy appearance (mottling). 

What are the late signs of sepsis? 

As sepsis progresses, it’s likely to worsen the early signs above. It may also lead to more symptoms, such as:

• Disorientation: Changes in mental status can develop or become more noticable, and they may even look like full-on disorientation or delirium.  

• Cool or pale skin: At first, the skin can feel warm with a fever. But as sepsis gets worse, hands and feet can become cool from a lack of circulation. The skin may also start to look pale or mottled. 

• Pain or discomfort: Sepsis itself does not cause pain. But it can lead to shivering or body aches that can be uncomfortable. Or if the underlying infection is cellulitis, this may become very painful as it worsens. 

• Extreme weakness: Sepsis can cause a person to feel extremely weak or tired. They may not be able to stand up or even move their arms or legs.

• Nausea, vomiting, and diarrhea: These can all be symptoms of a normal stomach bug. But they can also be signs of worsening sepsis — especially if the infection did not start with these symptoms or an intestinal infection. It’s particularly concerning if someone can’t stop vomiting. 

• Decreased urination: Someone with sepsis may become so dehydrated that they don’t have the urge to urinate for several hours. And sepsis can affect organs and cause kidney failure, making the decrease in urine output even worse.

The presence of these symptoms does not mean that someone definitely has sepsis. And this is by no means a comprehensive list. There’s a wide variety in the signs and symptoms of both early and advanced sepsis.

How serious is sepsis?

Sepsis is serious, especially if it progresses to more advanced stages. When left untreated, someone can develop severe sepsis and septic shock. This is when sepsis starts to cause organ dysfunction and failure. 

For example, the kidneys may shut down and stop producing urine. Or the lungs may start to accumulate fluid, and the person may have significant trouble breathing. And in septic shock, blood pressure significantly drops. 

Prompt recognition and intervention are critical when it comes to sepsis. So if you’re concerned about early signs of sepsis for yourself or someone you know, go to the emergency room (ER). 

Don’t second guess yourself about an ER trip when you or a loved one has an infection that seems to be getting worse, especially if it’s worsening over the course of hours. This is true even if you aren’t sure there’s an infection. You may see the signs of sepsis before you even realize there’s an infection.

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Written by:

Cherilyn Davis, MD

Cherilyn Davis, MD, is a board-certified pediatrician in New York City. She has held local and national roles at the American Medical Women’s Association including board member of the physician division and physician chair of social media.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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