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ctor Christopher Reeves, Pope John Paul II, Muppet-master Jim Henson, and actress Anna Nicole Smith probably shared little in life, but their pathway to death was painfully the same: sepsis. Sepsis, the body’s life-threatening response to infection, afflicts nearly 1 million Americans annually, causing more deaths yearly than prostate cancer, breast cancer, and HIV/AIDS combined, and costs the U.S. healthcare system nearly $17 billion. 1 Experts believe sepsis is the leading cause of death, collectively representing the majority of the mortality associated with HIV/AIDS, malaria, tuberculosis, pneumonia, and other infections acquired in the community, in healthcare settings, or by traumatic injury. Patients are at 10 times greater risk of death from sepsis after surgery than from a heart attack or pulmonary embolism.2
While an estimated 18 million cases of sepsis occur globally each year,3
there is also a lack of patient awareness about sepsis and its mortality rates. More than 80% of the general population in developed nations are unfamiliar with the term sepsis; 35% of Americans who have heard of the term are unable to define sepsis.4 Often, people first learn about sepsis when a loved one has died of complications due to surgery, pneumonia, or a urinary-tract infection that could not be controlled. Sepsis may lead to shock, multiple organ failure, and death especially if not recognized early and treated promptly.
Sepsis occurs more frequently in the young and the elderly; and in many hospitals, sepsis is the leading cause of death in non-coronary intensive-care units. In addition, anti-cancer drugs frequently render oncology patients susceptible to infection, with sepsis a major cause of death in this population. While ICU physicians and nurses know the risk of sepsis in seriously ill patients, healthcare professionals in other settings are often less aware and ill-prepared to recognize and deal with sepsis as a medical emergency.
Confusion exists among both medical professionals and patients with sepsis terminology, but advances in molecular medicine in understanding its pathophysiology is informing its definition and explanation. Sepsis is a systemic immune response to infection that turns against the body with potentially deadly consequences. It is not the infection itself and terms like septicemia, blood poisoning, healthcare-acquired infections, and bacteremia are not equivalent to sepsis or subsets of sepsis. Sepsis occurs when the foreign products of infectious agents (often bacterial, but include viral, fungal, and parasitic) activate the immune system which, in turn, releases cytokines and other mediators into the bloodstream. These mediators produce the major clinical signs and pathophysiological effects in the host that collectively create the sepsis syndrome. Sepsis is the final common pathway to death from infections — no matter what the source or the kind of infectious agent.
If not detected early and treated aggressively, sepsis can spiral quickly into a life-threatening situation. Sepsis is diagnosed based on the presence or suspicion of an infection (bacterial, fungal, or viral) plus one or more of the following: fever, increased respiration rate, increased heart rate, reduced blood pressure, or elevated white blood cell count. Sepsis is considered severe when multiple body organs begin to fail (kidney, heart, and lungs), while septic shock occurs when blood pressure drops to a life-threatening levels.
As previously noted, sepsis is under-recognized and poorly understood worldwide due to confusion about its definition, its lack of documentation as a cause of death on death certificates, inadequate use of diagnostic tools, and inconsistent application of standardized clinical guidelines to treat it as a lethal disease and a medical emergency. Early detection and aggressive treatment of sepsis can prevent the majority of sepsis deaths. Diagnostic tools that can identify sepsis early, and readily available interventions (e.g., fluids and antibiotics), can dramatically alter its course and improve survival if administered within the first hour of suspicion of sepsis.
Over the past year, sepsis experts have coalesced around the need for a global initiative to reduce the mortality of sepsis worldwide. Tackling sepsis as a major medical and public-health problem requires engaging many stakeholders and institutions, including medical societies, research labs, hospitals,and healthcare systems, governments, insurers, biopharmaceutical and diagnostic industries, and patient/consumer advocates. Significant progress is being made in harnessing power, leadership, and resources from the medical, scientific, and advocacy communities. In early October, the Feinstein Institute for Medical Research, research branch of the North Shore-LIJ Health System, hosted the international Merinoff Symposium 2010: SEPSIS, which addressed key issues from scientific, medical, communications, and policy perspectives. One outcome was a “call to action” to governments, healthcare providers, and philanthropic communities to focus on positioning sepsis as a medical emergency.
Christopher J. Czura, PhD is VP-Scientific Affairs for the Feinstein Institute for Medical Research, and Linda Distlerath, PhD, JD, is senior VP of APCO Worldwide, a public affairs and strategic communications firm. For more information about sepsis, visit www.sepsisalliance.org or www.globalsepsisalliance.org, or contact the authors at [email protected] and/or [email protected].
References
- Angus DC, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29:1303-1310.
- Moore L, et al. Sepsis in General Surgery. Arch Surg. 2010;145(7):695-700.
- Surviving Sepsis Campaign. Accessed at: http://www.survivingsepsis.com/campaign/background. Accessed on September 28, 2010.
- Dellinger RP, et al. An international survey: Public awareness and perception of sepsis. Crit Care Med. http://www.ncbi.nlm.nih.gov/pubmed/19123265. Accessed on September 28, 2010..
