An article in the August 23, 2016 edition of Washington Post outlines how the the CDC, Centers for Disease Control and Prevention has declared sepsis a medical emergency. The article reports that about 72 percent of patients with this fast-moving and deadly illness have recently been seen by doctors and nurses and many may have missed opportunities to catch it early or prevent it.
The most common illnesses leading to sepsis include pneumonia and infections of the urinary tract, skin and gut. There is no specific test for sepsis and symptoms can vary, which means it is often missed. But the report outlined several ways medical personnel could act, including vaccinating against pneumonia, preventing infections by washing hands and increasing general awareness of sepsis.
Deaths in 2016 of actress Patty Duke and boxing legend Muhammad Ali (and Muppets creator Jim Henson in 1990) have brought attention to sepsis. Interestingly, fewer than half of Americans know what the condition is.
Sepsis deaths are difficult to track because there is no test for it and no standard definition. As a result, death certificates may not offer a reliable count. But some figures suggest death rates are climbing. In-hospital deaths rose from 128,766 in 2009 to 159,690 in 2013, the Agency for Healthcare Research and Quality reported. Mortality is probably even higher than that, according to AHRQ, because its figures account only for primary and not secondary sepsis diagnoses.
Sepsis is most common among older people, the very young and those with compromised immune systems, particularly if they have chronic diseases such as AIDS, have had surgery or take immunosuppressant drugs such as steroids or chemotherapy. Along with antibiotic resistance and invasive surgeries, a rise in the use of those drugs is believed to be responsible for the higher sepsis numbers.[Medical errors now third leading cause of death in United States]
Even those well versed in sepsis debate how best to diagnose it.
His hospital, he said, made an astounding reduction in its sepsis mortality rate, from 49.1 percent in 2004 to 7 percent in 2015. The turnaround, Simpson said, came about not because of medical breakthroughs but from persistent efforts to catch it early and treat it quickly and aggressively, with antibiotics a mainstay of treatment.
Attention to the condition has been encouraged by a Medicare rating system that includes sepsis outcomes in hospitals. Yet many still fall behind, Simpson said.
In 2011, sepsis was the No. 2 reason for readmissions, following congestive heart failure. Forty percent of those sepsis readmits could have been prevented with timely and appropriate care, according to a study in the journal BMJ in 2015.
When sepsis is caught early, prognosis is very good, but mortality climbs to 25 to 30 percent for severe sepsis and 40 to 70 percent if septic shock occurs. “Early” can mean within a matter of hours. One study found that once a person goes into septic shock, chances for survival decrease 7.6 percent for every hour that it goes untreated.
Physicians trained to look for sepsis typically see warning signs in fever, elevated heart rate, elevated respiration and low blood pressure, said Henry Masur, chief of critical care medicine at the National Institutes of Health Clinical Center in Bethesda.
“So basically, outcome depends on fluids, blood pressure, antibiotics and source control. But it also depends on what organs are affected and underlying health status. Some people turn around in a few hours; some in days, weeks or months. Some will, unfortunately, die,” Masur said.
Knowing the symptoms
A rapid pulse, fast breathing, and swelling and red tissue should put people on guard. The most troubling symptoms are a combination of intense pain and mental confusion that worsens within a few hours, Simpson said. “If you have these symptoms, ask the doctor in these words: ‘Is this likely sepsis?’ ”
Practitioners also urge that people of all ages get vaccinated for the flu, that those older than 65 get vaccinated for pneumonia and that teenagers get vaccinated for meningococcal meningitis. These are among the infections that can lead to sepsis.