Winning the war against sepsis

Michael Wong, JD, Executive Director at the Physician-Patient Alliance for Health & Safety, posits a combination of quantitative and qualitative assessments of the patient as key measures for tackling sepsis

At the 4th World Sepsis Congress in April last year, healthcare experts from around the world gathered to discuss how to win the war against sepsis. Topics included early diagnosis and intervention, disadvantaged and marginalized patient populations, limited governmental healthcare support, post-sepsis syndrome, limited diagnostic and point-of-care testing availability, and data collection gaps.

The Global Sepsis Alliance defines sepsis as:

‘Sepsis arises when the body’s response to an infection injures its own tissues and organs. It may lead to shock, multi-organ failure, and death – especially if not recognized early and treated promptly. Sepsis is the final common pathway to death from most infectious diseases worldwide, including viral infections such as SARS-CoV-2 / COVID-19.’

Understanding sepsis risk factors

Sepsis attacks patients of all ages and socioeconomic status. The risks for sepsis increase due to conditions such as advanced age, comorbidities, injuries, lifestyle choices, and immune status. Victims of sepsis have a one in three chance of death, and the 30% that survive sepsis suffer from post-sepsis syndrome (which includes PTSD, organ dysfunction, chronic pain, and even amputations). Moreover, patients may return home to conditions that are suboptimal for recovery – they may have no running water, poor nutrition, or even a general lack of support systems.

Victims of sepsis often struggle with life challenges such as drug addiction, poverty, mental illnesses, and other physical ailments. The faces of sepsis tell important human stories:

• The 19-year-old woman with two children who is also an IV drug user.
• The nursing home patient with a Foley catheter.
• The severely mentally disadvantaged patient with contracted muscles develops sepsis from a tooth abscess.

Treating the underlying causes of sepsis

However, recognizing the many faces of sepsis is a must; according to Amy Campbell, PhD, RN, CPHQ, LSBB (Quality Nurse Specialist, ECU Health) – ‘If we aren’t able to treat the underlying condition that resulted in the development of sepsis, the 19-year old mother, the nursing home patient, and the patient with a tooth abscess will all be re-admitted to the hospital for sepsis. In the case of the 19-year-old mother, it was her IV drug use and the needles she was using that caused her sepsis – not treating her drug addiction meant that she had repeated emergency room visits.’

Seeing the patient as an individual to treat the underlying cause of sepsis is just one part of the equation for beating sepsis – the qualitative part.

Improving diagnosis and treatment

Other presenters at the 4th World Sepsis Congress discussed the role of technology in improving the timely diagnosis and treatment of sepsis. Successful point-of- care testing (POCT) protocols need to be affordable, sensitive, rapid, specific, user-friendly, and avoid elaborate instrumentation. Future advances in point-of- care testing (POCT), biomarker expansion, sequencing, and predictive analytics provide a hopeful scenario for improved test results and turnaround times, leading to timely treatment protocols, thus improving patient outcomes. Here, the quantitative and the qualitative could come together to provide a complete diagnosis and treatment of the patient. For example:

• François Ventura, MD, MBA (University Hospitals of Geneva, Switzerland) said that there is currently no accepted biomarker used to diagnose sepsis. Could the use of a biomarker that indicated the presence of sepsis mean more time to recognize the patient’s abscessed tooth was the cause of his sepsis?
• Rishi Kamaleswaran, PhD (Emory University, United States of America), spoke about the importance of bioinformatics in the development of predictive analytics using robust data collection. Could predictive analytics have foreseen the Foley catheter causing sepsis in the nursing home patient?

The dictionary defines war as defeating an enemy or an opponent. Sepsis is an opponent worthy of significant fighting resources. According to the Global Sepsis Alliance:

‘Sepsis is a global health crisis. It affects between 47 and 50 million people every year; at least 11 million die – one death every 2.8 seconds. Depending on the country, mortality varies between 15 and more than 50%. Many surviving patients suffer from the consequences of sepsis for the rest of their lives.’

Winning the war against sepsis will mean bringing together the qualitative (treating the 19-year-old mother for her IV drug addiction) as well as the quantitative (POCT to diagnose the presence of sepsis).

To listen to the 4th World Sepsis Congress presentations and to receive continuing medical education credits, please click here.