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Sepsis present in more than half of hospital deaths

In United States hospitals, sepsis was a leading cause of death; however, most deaths were not preventable through better hospital care, according to findings published in JAMA Network Open.

“Sepsis is present in many hospitalizations that culminate in death,” Chanu Rhee, MD, MPH, assistant professor of medicine at Brigham and Women’s Hospital, and colleagues wrote. “The contribution of sepsis to these deaths, and the extent to which they are preventable, is unknown.”

Rhee and colleagues conducted a cohort study to estimate the prevalence of sepsis-associated mortality in acute care hospitals and how preventable these deaths are.

The researchers studied 568 patients (50.9% men; mean age, 70.5 years) who died in one of six hospitals in the United States or were discharged to hospice and not readmitted between Jan. 1, 2014, and Dec. 31, 2015.

They used Sepsis-3 criteria to assess for sepsis during hospitalization. They also measured hospice-qualifying criteria on admission, immediate and underlying causes of death and suboptimal sepsis-related care, including inappropriate or delayed antibiotics, inadequate source control and other medical errors. The 6-point Likert scale was used to measure the preventability of each sepsis-associated death.

Sepsis was observed in more than half of hospitalizations (52.8%; n = 300). In 34.9% of cases (n = 198), sepsis was the primary cause of death. Progressive cancer (n = 92; 16.2%) and heart failure (n = 39; 6.9%) were the next most common immediate causes of death.

In patients with sepsis, solid cancer (21%), chronic heart disease (15.3%), hematologic cancer (10.3%), dementia (9.7%) and chronic lung disease (9%) were the most frequent underlying causes of death.

Upon hospital admission, 40.3% of sepsis-related deaths showed signs of hospice-qualifying conditions, such as end-stage cancer.

In 22.7% of sepsis-related deaths, suboptimal care, most notably delays in antibiotics, was observed. Only 3.7% of sepsis-related deaths were considered definitely or moderately preventable and 8.3% were potentially preventable.

“Our findings do not diminish the importance of trying to prevent as many sepsis-associated deaths as possible, but rather underscore that most fatalities occur in medically complex patients with severe comorbid conditions,” Rhee and colleagues concluded. “Further innovations in the prevention and care of underlying conditions may be necessary before a major reduction in sepsis-associated deaths can be achieved.”

In a related editorial, Laura Evans, MD, MSc, medical director of critical care at Bellevue Hospital, New York, wrote that the findings by Rhee and colleagues should act as a reminder to advance sepsis research.

“Early recognition and prompt management of sepsis has been demonstrated in numerous studies to be associated with improved patient outcomes, and current clinical practice guidelines emphasize this concept,” Evans wrote. “This study does not change this established priority for early identification and management of patients with sepsis. The need for improved rapid diagnostics that can be used to trigger time-sensitive interventions that can be applied across different resource settings is urgent to reduce sepsis-associated deaths to their lowest possible levels.” – by Alaina Tedesco

Disclosures: Evans reports being on the steering committee of the Surviving Sepsis Campaign and being co-chair of the Surviving Sepsis Campaign Guidelines. Rhee reports receiving royalties and personal fees from UpToDate and grants from the Agency for Healthcare Research and Quality and CDC. Please see study for all other authors’ relevant financial disclosures.