Madonna's ICU Stay May Have Been Due to Sepsis

Global superstar Madonna is recovering from a stay in the intensive care unit (ICU) for what her manager described on Instagram as a "serious bacterial infection" -- which emergency physicians suspect may have been sepsis.

Avir Mitra, MD, an emergency medicine physician and assistant professor at the Icahn School of Medicine at Mount Sinai in New York City, who is also a spokesperson for the American College of Emergency Physicians, said that people get bacterial infections all the time, such as urinary tract infections, pneumonia, or even pimples.

"But the most important thing that we get worried about is ... sepsis," Mitra said. "That's probably what she had if she had to be in the ICU," though he noted bacterial meningitis is also a possibility.

According to Mitra, sepsis occurs when an infection spreads throughout the body "and the immune system is so revved up to fight that infection, that it actually starts sort of fighting the body."

"Your immune system is going so haywire that basically a lot of the fluid in your body is leaking out from where it should be, like in your blood vessels, and ... going in all the wrong places and your blood pressure starts to drop," he said. "That's how you die from sepsis. You go into shock."

Despite being so deadly, sepsis is surprisingly easy to miss. The Sepsis Alliance notes that a septic patient's risk of death increases 4% to 9% each hour treatment is delayed. However, if sepsis is quickly identified and treated, around 80% of patients can be saved.

Mitra told MedPage Today that sometimes patients with sepsis look really sick, with symptoms like pain, fever, and chills. But other times, especially early on, the patient doesn't display these warning symptoms. Lab cultures are a gold standard for confirming sepsis, but Mitra said those tests can take days -- time the patient doesn't have.

Most of the time, doctors use systemic inflammatory response syndrome (SIRS) criteria to assess patients.

"Basically it's like if their heart rate ... is fast, if they're breathing fast, if their ... white blood cell count is super high or super low, and if their temperature is super high or super low," said Mitra. "If those things are positive ... we become suspicious that they're septic."

While young, healthy people can get sepsis, risk increases with age and other factors. The CDC lists people age 65 and older, those with weakened immune systems, and those with chronic conditions as some of the groups most likely to get sepsis. Madonna will turn 65 in August. The latest update on the superstar is that she has been discharged and is recovering at home.

Sepsis also can be triggered by infections in the lungs, urinary tract, skin, or gastrointestinal tract, according to the CDC.

"Usually when people say 'serious bacterial infection,' it's usually implying ... [that] the bacteria went systemic and the inflammatory system went berserk, which is sepsis," Mitra continued. "And if they're in the ICU, usually they progressed to septic shock, where their blood pressure isn't able to stay maintained because they're just running out of fluids basically."

Doctors give patients IV fluids and antibiotics, but once someone is in septic shock, they also use pressors, or drugs that help raise blood pressure. Needing blood pressure support is usually why sepsis patients need to be in the ICU, Mitra explained.

He used the analogy of a gas tank: "If you see that your gas tank is low, the first thing you're gonna do is fill up your gas. So that's what we do with fluids. But if you fill up the gas tank, and then you see that it goes low again, you know there must be a leak somewhere," said Mitra, noting that's when treatments like pressors come in.

Mitra said in his clinical experience, "turning the ship around" is the hardest part, and that once a patient begins to get better, they keep getting better. To recover, patients stay under medical care receiving antibiotics and resting until they're discharged.

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