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Sepsis accounts for large percentage of hospital deaths
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Sepsis contributed to one in every two to three hospital deaths, according to a research letter published in JAMA.
“We believe it’s important for providers and the public to understand the worrisome signs and symptoms resulting from sepsis — the inflammatory syndrome that occurs in severe infection which can quickly progress to organ dysfunction or failure,” Vincent Liu, MD, of the Kaiser Permanente Division of Research in Oakland, Calif., told Infectious Disease News. “Identifying patients with sepsis early in their disease course is essential so we can initiate treatment and prevent further deterioration.”
Vincent Liu
Liu and colleagues examined the role of sepsis in hospital mortality in two large cohorts of adult inpatients. The first cohort, from Kaiser Permanente Northern California (KPNC), included 482,828 adults with overnight hospitalizations at 21 KPNC hospitals between 2010 and 2012. The second was the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). The NIS is a nationally representative sample of 1,051 hospitals, consisting of 6.5 million adult hospitalizations in 2010.
The researchers identified explicit cases of sepsis using ICD-9 codes and added implicit cases based on codes identifying infection and organ failure.
In the NIS cohort, there were between 280,663 explicit (4.3%) and 717,718 implicit (10.9%) sepsis hospitalizations. Results also indicated that there were between 55,008 explicit (11.4%) and 80,678 implicit (16.7%) sepsis hospitalizations in the KPNC cohort, and most of these patients had sepsis on admission. Of the 14,206 deaths in the KPNC cohort, 36.9% to 55.9% occurred in patients with sepsis — almost all of whom had sepsis on admission, according to Liu and colleagues. Of the 143,312 deaths in the NIS, 34.7% to 52% occurred among patients with sepsis.
In a subset of KPNC patients with sepsis, those who were eligible for early goal-directed therapy comprised 32.6% of deaths resulting from sepsis.
A majority of sepsis deaths occurred in patients with less severe sepsis, according to Liu and colleagues. In the past, efforts to improve standardized care have focused on the most severely ill patients, but more attention should be given to patients with less severe sepsis to reduce hospital mortality, they said.
“Given the prominent role it plays in hospital mortality, improved treatment of sepsis (potentially a final hospital pathway for multiple other underlying conditions) could offer meaningful improvements in population mortality,” the researchers wrote.
Liu said more research is needed to “improve our understanding and treatment for sepsis, which still carries a very high mortality. Prior studies have shown that sepsis research funding is disproportionately low relative to its incidence, impact and cost. This study underscores the need for research in improving our sepsis care.” – John Schoen
Disclosure: One of the researchers received nonfinancial support from Edwards Inc.; personal fees from Eli Lilly, Ferring Pharmaceuticals, MedImmune LLC, Pfizer and Roche Diagnostics International Ltd.; and a grant from Eisai Inc. None of the other researchers report relevant financial disclosures.
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