Doctors say greater awareness, faster treatment will improve survival rates
DECATUR, Ga. (MarketWatch) — Sepsis is a leading cause of death in American hospitals, but ask most people what sepsis is, and they’ll give you a blank stare.
About 750,000 Americans get sepsis every year at a cost of $17 billion to the U.S. health-care system, and about 200,000 die from it, according to the Global Sepsis Alliance, a coalition of 250,000 intensive- and critical-care physicians.
Calgary weighs private options for health care
In Canada, rising health-care costs are prompting a call for changes to the country's popular public program. The Chamber of Commerce is making its case for a greater role for the private sector. MarketWatch's Kristen Gerencher reports from Calgary, Alberta.
But 60% of Americans are unfamiliar with sepsis, and 30% who have heard the word can’t define it, according to a recent poll commissioned by the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System in Manhasset, N.Y.
Sepsis is a global medical emergency with 18 million cases internationally every year, according to 150 medical professionals, researchers and policymakers from 18 countries, who attended the Merinoff Symposium, an international sepsis conference, in September.
As a key first step to increasing public familiarity of sepsis, the group ratified a new definition of the disease. “It’s a major problem when the leading killer can’t even be described,” said Dr. Kevin J. Tracey, president of the Feinstein Institute, which hosted the symposium. “People need to know what it is in order to incite the response necessary to cure it.”
Tracey urges doctors, media and other stakeholders around the globe to use this definition routinely: “Sepsis is a life-threatening condition that arises when the body’s response to an infection injures its own tissues and organs.”
That is, you contract another disorder, such as flu, pneumonia, cancer, bladder infection, appendicitis, skin infection, trauma, or any other bacterial, viral or fungal infection, including MRSA and other hospital-acquired infections, but it’s the body’s severe protective reaction to that infection, not the infection itself, which may lead to septic shock, multiple organ failure and death.
Complicating and often delaying diagnosis, initial symptoms of septic patients resemble those for other disorders, including low blood pressure, fever or chills, trouble breathing and general weakness.
Surgical patients who develop an infection and then sepsis stay in the hospital almost 11 days longer, at a cost of $32,900, and one in five die, according to a study of 1998-2006 discharge records reported in the September 2010 issue of Infection Control Today.
At Ohio State University Medical Center, one third of the patients on the intensive care unit at any given time have sepsis, said James M. O’Brien, an ICU doctor at the Columbus hospital and a board member of the Global Sepsis Alliance. More public awareness of sepsis can only improve doctor-patient communication, he said.
“A big part of my job is giving people bad news and telling them that their loved one is dying or has died,” he said. “It’s difficult in all circumstances, but it’s even more difficult when their loved one is dying of something that the family has never heard of.”
Even the healthy are susceptible
Chances are someone you know has had sepsis, but even the patient may not know because many physicians avoid the term, O’Brien said.
A 2004 survey of 1,000 physicians in Europe and U.S. found agreement that sepsis is a leading cause of death in critical-care units and that similar symptoms to other conditions may lead to under-reporting. However, only 10% called the diagnosis “sepsis” when speaking to patients’ relatives, while 85% referred to sepsis as a “complication” of another condition.
You may be more susceptible to sepsis if you have a weakened immune system due to an illness such as cancer or AIDS or because of medical treatments such as chemotherapy, steroids or an organ transplant. Seniors and babies, whose immune systems are not fully developed, are also at greater risk.
But healthy people of all ages contract sepsis, O’Brien said. “In all honesty, we don’t know why when you take 10 people and expose them to an infectious agent, [such as] a bacteria, some of them never get the bacteria, some get the infection and get better, and some develop sepsis and die from it,” he said.
A year ago, Jennifer Ludwin, a 23-year-old Ohio State University graduate student, ran daily and was completely healthy. Then in October 2009, she developed a severe sore throat and high fever and began coughing up blood.
On her first emergency room visit, Ludwin received fluids and was sent home. A few days later, when her symptoms worsened, she returned and was admitted with H1N1 flu so severe her body triggered septic shock.
Ludwin remained hospitalized for 100 days. Her sepsis was so invasive and fast-spreading that to halt its progress, surgeons had to remove her gall bladder, perform a thoracotomy on her left lung, and amputate her legs below her knees, all her fingers on her left hand and partial digits on her right hand. She has had 18 surgeries to date with more to come.
“It’s a weird feeling because you realize you came so close to dying, but you have no memories of it,” Ludwin said. “In a way you don’t believe it. My parents even had to discuss funeral arrangements for me.”
Fast treatment crucial to survival
Research studies have found that hospital deaths from sepsis could be reduced significantly by the simple practice of administering antibiotics and fluids sooner, O’Brien said.
“With septic shock, delays of antibiotics by even 30 minutes can prevent someone from dying,” he said. “The chance of dying goes up 8% per hour of delayed antibiotics.”
At Ohio State University Medical Center, an investigation of antibiotic orders by emergency physicians found an up-to-four-hour delay between prescription and patient delivery. Now if a patient comes into the emergency room with low blood pressure, a key indicator for septic shock, antibiotic orders default to a high priority category for immediate dispensing, O’Brien said.
Attendees of the Merinoff Symposium issued a statement calling for initiating antibiotics, fluids and other emergency actions “within one hour of suspicion of sepsis.” Meanwhile several large U.S. health-care systems are speeding up procedures for patients with sepsis symptoms, including North Shore-LIJ, which operates 28 facilities and services in New York state.
North Shore-LIJ’s program launched last year and already the system saw its mortality rate for septic patients drop to about 19% in June 2010 from 26% in 2008, said Dr. Kenneth J. Abrams, the health system’s associate chief medical officer.
His dream is that soon early intervention for sepsis will be as routine as that for heart attacks. “Today, a patient feels chest pain, self-administers an aspirin at home, then oftentimes therapy begins with an EKG transmitted to the hospital from the ambulance,” Abrams said. “A team is waiting to care for the patient upon hospital arrival and he’s in the cath lab within 60 to 90 minutes.”
About $100 million in U.S. research dollars is spent on sepsis annually, compared to about $700 million for breast cancer and about $300 million for stroke or prostate cancer, according to National Institutes of Health data.
Anya Martin is a freelance writer, based in Decatur, Ga.