Background
Severe Sepsis
Severe sepsis is a complex and often life-threatening condition. It can affect anyone, but often develops in patients with pneumonia, trauma, surgery, burns or cancer.
Quick Facts
- Over 18 million cases of severe sepsis worldwide each year (2)
- Up to 135,000 European and 215,000 American deaths each year (2, 7)
- Kills approximately 1,400 people worldwide every day (5)
- Severe sepsis is the leading cause of death in the non-coronary ICU (5)
- Each year sepsis costs €7.6 billion in Europe and €17.4 billion in the US (2, 5)
Definition and Diagnosis
Sepsis is a complex syndrome that is difficult to define, diagnose and treat. It is a range of clinical conditions caused by the body’s systemic response to an infection, which if it develops into severe sepsis is accompanied by single or multiple organ dysfunction or failure leading to death.
Only recently have intensive care professionals begun to understand the mechanism of sepsis. There is still disagreement within the global medical community surrounding the terminology and best methods of identifying the onset and progress of the condition. The lack of clear clinical definitions makes the diagnosis and management of sepsis a clinical challenge.
Diagnosis can be difficult as some of the symptoms of sepsis, such as fever, rapid pulse and respiratory difficulty, are very general and can be found in many other disorders. In a recent survey conducted among physicians 87% felt that the symptoms of sepsis can easily be attributed to other conditions, creating problems of late or misdiagnosis (1).
A universally accepted definition would be a vital first step in aiding the medical community to effectively manage sepsis, with 81% of physicians surveyed recognising that a lack of a common definition could potentially lead to delays in treatment and additional complications or death of the patient (1).
How Many People are Affected?
Over 18 million cases of severe sepsis occur each year – that’s equivalent to the entire population of Denmark, Finland, Ireland and Norway added together each year (2).
Worryingly, the number of severe sepsis cases is set to grow at a rate of 1.5% per annum from the current annual incidence of 3.0 cases per 1,000 of the population (2). This amounts to an additional 1 million cases per year in the USA alone by 2020 (2). The increase is mainly due to the growing use of invasive procedures and increasing numbers of elderly and high-risk individuals such as cancer and HIV patients. Older people are at increased risk of sepsis as they are more prone to infections due to ageing, co-morbidities, use of invasive surgical techniques and problems associated with institutionalisation.
Mortality
Sepsis is a major cause of mortality throughout the world, killing approximately 1,400 people worldwide every day (5). The real figure may, however, be as high as an additional 50% as deaths are often attributed to complications from cancer or pneumonia, and not from sepsis.
Death is common among sepsis patients, with around 28–50% of patients dying within the first month of diagnosis (3, 4, 6, 9, 10).
Personal and Economic Impact
Sepsis impacts the lives of many people, including the patient and their families, in addition to doctors, nursing and care staff.
The patient may spend months in hospital, including time in the intensive care unit (ICU). Family and friends may have to care for the patient for many months after release from hospital. The personal costs endured by the sepsis patient and their family are immense; these include pain, suffering, disability and the psychological affects on the sufferer and family. In addition, the cost for survivors is high, with their long-term quality of life significantly lower than the general population (8).
In most countries, the management of the sepsis patient is led by the intensivist, pulmonologist, critical care physician or ICU anaesthetist. However, many other healthcare professionals provide consultation and support, including infectious disease physicians, emergency room physicians, surgeons, oncologists, haematologists, urologists, nephrologists, internal medicine physicians, family practitioners, pharmacists and nurses.
The intense demands made on hospital staff, equipment and facilities to treat sepsis patients places a significant burden on healthcare resources, accounting for 40% of total ICU expenditure (5). Each year the cost of treating sepsis patients increases and is currently as high as €7.6 billion in Europe (5) and €17.4 billion in the USA (2).
Interventions
Treatment is more likely to be effective, and severe sepsis avoided, if appropriate therapy is used early. Once diagnosed, the first-line treatment is to eliminate the underlying infection with antibiotics. Depending on the patient’s clinical status, additional therapies are initiated, including drug therapy and supportive care, such as mechanical ventilation and kidney dialysis.
There has been considerable excitement recently amongst critical care clinicians who care for patients with sepsis. Recent trials involving new therapeutic interventions have demonstrated, for the first time in 20 years, improved survival in patients with severe sepsis and septic shock
The Future
Despite the projected increase in sepsis patients in the future, there are specific opportunities to improve the management of the condition. Improvements can be made by identifying patients earlier through the use of globally accepted definitions, treating with the most appropriate medication and adopting agreed standards of care – all these initiatives will assist in reducing mortality. Also, there is hope with the introduction of more new exciting therapies, which will assist physicians in their management of sepsis.
References
- Sepsis: a study of doctors knowledge about sepsis in five European countries and the US; ESICM and SCCM: January 2001.
- Angus DC et al. Crit Care Med 2001; 29: 1303–10.
- Rivers E et al. N Engl J Med 2001; 345: 1368–77.
- Natanson C et al. Crit Care Med 1998; 26: 1927–31.
- Bone RC et al. Chest 1992; 101: 1644–55.
- Bernard GR et al. N Engl J Med 2001; 344: 699–709.
- Davies A et al. A European estimate of the burden of disease in ICU. In preparation.
- Heyland DK et al. Crit Care Med 2000; 28: 3599–605.
- Briegel J et al. Clin Invest 1994; 72: 782–7.
- Bollaert PE et al. Crit Care Med 1998; 26: 645–50.
