Sepsis: A Deadly and Costly Crisis

Sepsis is prevalent around the world and directly impacts population health. A 2017 study estimates that nearly 49 million people were diagnosed with sepsis worldwide, contributing to more than in 11 million deaths.1 In 2012, the Global Sepsis Alliance initiated World Sepsis Day (September 13) to raise global awareness of sepsis and to reduce sepsis-related deaths.

While the burden of sepsis is highest in low- and middle-income countries, sepsis does not discriminate across ethnicity, nationality, and color, playing an important role in morbidity and mortality around the globe. The incidence of sepsis is growing considerably and remains one of the deadliest and most expensive conditions.

 

sepsis:  the body's response to infection

Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death. Treatment and complications arising from sepsis can result in extended hospital length-of-stay and readmissions and, as such, has a tremendous financial impact on healthcare. Sepsis patients can cost 6 times more to treat than non-sepsis patients, with trends showing increased hospital admissions due to sepsis and increased in inpatient hospital death rates since the early 2000s.2 Despite established evidence-based guidelines, the mortality rate for septic shock is still 40-70%.2

Sepsis at a glance
  • Sepsis is the body’s overwhelming and life-threatening response to infection that can lead to tissue damage, organ failure, and death.
  • A study estimates there were 49 million cases of sepsis diagnosed worldwide in 2017, contributing to 11 million deaths.1

While onset and severity are closely related to a patient’s risk status, anyone regardless of health status can develop sepsis including not only those of advanced age, but also newborns and those with underlying infectious diseases, such as HIV/AIDS, liver diseases, cancer, and autoimmune disorders. Early signs can be subtle and hard to detect, especially in unsuspecting patient populations, such as young adults, further compounding the complexity of sepsis management.

Patients with symptoms related to sepsis frequently present in the emergency department (ED) as urgent cases. Patients are likely to be treated in critical areas of the hospital including the ICU, CCU, and Surgical ICU. In fact, sepsis is a common diagnosis among those admitted to the ICU.3 In ICU patient populations, it may also be difficult to diagnose sepsis quickly because symptoms may resemble complications from other underlying diseases or conditions.

 

Creating awareness

Public awareness of sepsis varies by country, but is low globally. In Germany – the home of the Global Sepsis Alliance and World Sepsis Day – approximately half (49%) of a surveyed population has heard of sepsis. In contrast, in Brazil, that number was 6.6%.4 

 

Sepsis patients cost 6 times more to treat than non-sepsis patients.

Solving the problem

Regardless of this low awareness, as a medical emergency, the ability to quickly diagnose and treat sepsis remains the best way to reduce mortality and severity of long-term complications, such as chronic pain, fatigue, organ dysfunction, and limited mobility. Speed is key, with evidence showing that for every hour that sepsis treatment is delayed once the patient has developed hypotension, the risk of death increases by 8%.8

Point-of-care lactate testing, which offers providers the ability to immediately test patient samples at the bedside, can help accelerate risk stratification of patients diagnosed with sepsis.6 With this added insight, patients at risk of higher mortality, including those with septic shock, can be identified sooner and immediate resources and care can be directed to those that need it most.

In the last several years, there has been a great deal of focus on targeted programs to reduce sepsis. In 2018, the Surviving Sepsis Campaign Bundle was updated to combine the 3-hour and 6-hour bundles into a single “hour-1 bundle,” which includes the measurement of lactate.7 Several other organizations have created sepsis “bundles” and sets of evidence-based practices as well, including the World Health Assembly, the Institute for Healthcare Improvement and the National Quality Forum.

For every hour that sepsis treatment is delayed once the patient has developed hypotension, the risk of death increases by 8%.8

References

1. Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet (London, England). 2020;395(10219):200-11.
2. The Advisory Board Company. Ten Imperatives to Reduce Sepsis Mortality 2013. 
3. Genga KR, Russell JA. Update of Sepsis in the Intensive Care Unit. J Innate Immun. 2017;9(5):441-455. 
4. Simon Finfer, Flavia R. Machado. The Global Epidemiology of Sepsis. Does It Matter That We Know So Little? AJRCCM Issues. Vol. 193, No. 3 | Feb 01, 2016.  
5. Sepsis Alliance.  Sepsis Fact Sheet. 
6. Shirey, Terry L. PhD. POC Lactate: A Marker for Diagnosis, Prognosis, and Guiding Therapy in the Critically Ill. Point of Care: The Journal of Near-Patient Testing & Technology: September 2007 - Volume 6 - Issue 3 - p 192-200.   
7. Levy, Mithcell M, et al. The Surviving Sepsis Campaign Bundle: 2018 update
8. Kumar et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. June 2006. https://www.ncbi.nlm.nih.gov/pubmed/16625125

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