Hospitals are stepping up efforts to quickly recognize and treat sepsis, the deadly body-wide infection which is often not recognized until it is too late, today’s Informed Patient column reports.
Experts agree that early diagnosis and prompt treatment with antibiotics can prevent sepsis from progressing to severe disease, which can result in long-term disability and death. But researchers continue to study how best to manage the disease once it sets in. The nonprofit Institute for Healthcare Improvement is collaborating with several organizations to revise and update guidelines, including the Surviving Sepsis Campaign, an initiative by a group of critical-care organizations.
The National Institutes of Health is funding a study led by the University of Pittsburgh Medical Center, called the Protocolized Care for Early Septic Shock, to determine whether specific interventions can halt the progression to severe sepsis and septic shock. The study will test ways of managing the disease during the first six hours after diagnosis, with a protocol that includes a sequence of resuscitation methods to deliver fluids, restore blood pressure, and monitor cardiovascular function and other organ activity.
The protocol was developed several years ago at Henry Ford Hospital in Detroit, where it was shown to increase survival rates. But questions over the rigor of the research led to controversy, as the WSJ wrote about in 2008. The UPMC study aims to also show whether the approach will have similar success at multiple institutions around the country.
Derek Angus, lead researcher on the UPMC study, tells the Health Blog that his team will also study long-term consequences of severe sepsis to see, for example, whether it triggers cognitive problems and an increased risk of cardiovascular disease. While more people are surviving sepsis thanks to advances in intensive care units, researchers are also just starting to understand the long term-consequences for survivors, including impaired cognitive function.
A study published last October in the Journal of the American Medical Association concluded that severe sepsis in older patients is associated with “substantial and persistent new cognitive impairment and functional disability among survivors.”
“Septic events trigger such huge responses in the body that the clock sometimes doesn’t reset properly,” Angus says. For example, sepsis patients may go home from the hospital appearing to have recovered, “but a significant portion still have some inflammation under the surface and are more likely to be in trouble in the coming months,” especially older patients, he says.
“We are seeing some improvements in short-term mortality but we may be creating a second problem of having an ever-expanding population of sepsis survivors,” Angus adds. “It’s not enough to have people not die — we really need to think about how we help people recover from sepsis.”
That’s also the conclusion reached by researchers from the Medical College of Wisconsin and the Orlando Regional Medical Center. In a study of nationwide sepsis trends published in July in the journal Chest, researchers reported that in proportional terms, the improvement in mortality between 2000 and 2007 was matched exactly to the number of survivors being discharged either to skilled-nursing facilities or home-health care.
Mortality from severe sepsis dropped to 27% from 39%, while death from septic shock dropped from 47% to 36%. But 35% of discharges were made to a long-term care facility in 2007 versus 27% in 2000 and the proportion of discharged patients needing home care rose from 8% to 12%.
“We have to meet the needs of this population and measure success by their ability to go on to independent living and avoid re-hospitalization after surviving sepsis,” says Rahul Nanchal, a Medical College of Wisconsin researcher and an author of the study.