Sepsis — life-threatening organ dysfunction due to a dysregulated response to infection — is a major public health problem worldwide. Although mortality due to sepsis has improved, sepsis remains a leading cause of death, with in-hospital mortality ranging from 12 to 26 percent. Advances in clinical care and research for sepsis have been hampered by disparate terminology for and approaches to the definition of sepsis and its components.
[Photo: Mr. John Donnelly]
The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) present clinical criteria for the classification of patients with sepsis. We investigated incidence and long-term outcomes of patients diagnosed with these classifications, which are currently unknown.
We did a retrospective analysis using data from 30 239 participants from the USA who were aged at least 45 years and enrolled in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Patients were enrolled between Jan 25, 2003, and Oct 30, 2007, and we identified hospital admissions from February 5, 2003, to Dec 31, 2012, and applied three classifications: infection and systemic inflammatory response syndrome (SIRS) criteria, elevated sepsis-related organ failure assessment (SOFA) score from Sepsis-3, and elevated quick SOFA (qSOFA) score from Sepsis-3. We estimated incidence during the study period, in-hospital mortality, and 1-year mortality.
“It’s something that you handle on the inpatient side and then that’s it, but we have to move outside the hospital,” said Mr. John Donnelly, doctoral candidate in the department of Epidemiology, and first author of the study published in The Lancet.
It is estimated that 20 to 35 percent of people with severe sepsis die. “Our vision with regard to this sepsis study is to show that sepsis in fact could be a preventable disease; 50 years ago we believed that heart attack and strokes were random events, things that we could do nothing about. Today we know that is not the case. Medicine and lifestyle help to prevent those conditions, said one of the co-authors, Dr. Henry Wang, Vice Chair for Research in the UAB Department of Emergency Medicine.
The revised sepsis classifications are useful for identifying patients at increased risk of poor outcomes during hospital stays. In addition to serving as an in-hospital screening tool, the revised classifications might also be useful for the characterization and identification of patients with infection who are at increased risk of poor outcomes after discharge. Further study is needed to establish whether widespread use of the revised classifications would lead to improved outcomes.
Other authors include: Dr. John Baddley, associate professor, division of infectious disease at UAB, Dr. Monika Safford, chief of divison of general internal medicine at Weill Cornell Medical College, and Dr. nathan shapiro, department of emergency medicine at Beth Israel Deaconess Medical Center.
For the full published article go to: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(17)30117-2/fulltext