As part of World Sepsis Day, we cover a recent study into newly implemented sepsis protocols. It concludes that they improve care and decrease the risk of death by 15 percent.
Often referred to as blood poisoning, sepsis is a serious condition that is caused by an immune response to an infection becoming out of control.
The immune reaction can lead to widespread inflammation, which can end in organ failure.
Sepsis can also cause leaky blood vessels and blood clots, interfering with the movement of blood and depriving organs and tissues of oxygen.
In severe sepsis — also called septic shock — blood pressure plummets, putting the patient’s life at risk.
There are more than 1.7 million cases of sepsis in the United States each year and around 270,000 result in death. Of all deaths that occur in hospital, 1 in 3 are due to sepsis.
Sepsis is also a leading cause for hospital readmission — it can occur unpredictably and progress frighteningly quickly. Therefore, understanding how best to diagnose and manage sepsis is of utmost importance.
Recently, New York State released a mandate that requires all hospitals to comply with protocols to treat sepsis and septic shock. The decision was a reaction to the 2012 case of Rory Staunton, an otherwise healthy 12-year-old from Queens, NY, who died because sepsis was not recognized.
Now, Dr. Mitchell M. Levy and colleagues from Warren Alpert Medical School of Brown University in Providence, RI, have assessed whether the New York State mandate is having the desired effect.
As Dr. Levy points out, “Governor Andrew Cuomo and then Commissioner of Health Nirav Shah responded to Rory’s preventable death by mandating public reporting of sepsis process and outcomes, with the goal of improving earlier diagnosis and management of sepsis.”
Their findings were published in the American Journal of Respiratory and Critical Care Medicine.
The state adopted “bundles.” These 3- and 6-hour bundles are sets of interventions that ensure the early diagnosis and treatment of sepsis.
The 3-hour bundle for people with severe sepsis — which must take place within 3 hours of arriving at hospital — includes drawing blood cultures before giving antibiotics, starting antibiotic treatment, and assessing the levels of lactate in the blood, which is an important marker for sepsis.
The 6-hour bundle for people who have septic shock — which must be carried out within 6 hours of arriving at hospital — includes intravenous fluids, vasopressors (drugs that contract blood vessels), and a follow-up check on lactate levels.
“The reason the state adopted these particular bundles is that our group had published evidence that there was a strong association between compliance with these interventions and improved survival in sepsis.”
Dr. Mitchell M. Levy
Along with the changes to sepsis protocol — which the media refer to as Rory’s Regulations — that New York State implemented, they also became the first state to make it mandatory to report all cases of sepsis to the Department of Health.
Dr. Levy and his team had access to these data for their latest study.
The researchers took data from 91,357 patients with sepsis or septic shock over the first 27 months that the protocols came into force. Data were taken from 183 hospitals.
They found that the sepsis bundles were used in 81.3 percent of patients. They also showed that, across the initial months of Rory’s Regulations, the level of compliance slowly increased across hospitals.
Importantly, the patients to whom the bundles were administered had a mortality risk of 24.4 percent; patients to whom the bundles were not administered had a mortality risk of 28.8 percent.
Similarly, the hospitals that followed protocols more rigorously saw a reduction in the average length of hospital stay.
“The New York State sepsis initiative provides strong evidence that compliance with sepsis performance measures is associated with improved survival in these critically ill patients.”
Dr. Mitchell M. Levy
The public reporting of patient outcomes is a growing movement, nationally. There is much debate surrounding the pros and cons, but, as Dr. Levy explains, “At least in sepsis, our study strongly supports the value of public reporting of outcomes.”
World Sepsis Day is now held every year in order to raise the profile of this surprisingly prevalent and life-threatening condition. Prof. Konrad Reinhart, chair of the Global Sepsis Alliance, explains:
“We are appealing to the United Nation Member States and the WHO [World Health Organization] to take immediate action on their commitment to prioritize the devastation caused by sepsis worldwide, to issue a report on the prevalence and consequences of sepsis, and to support its member nations globally in the prevention, diagnosis, and management of this preventable global health issue.”
There is still much to be done, however; as the press release for World Sepsis Day 2018 neatly claims, “In resource-rich countries with strong health systems, sepsis inflicts […] 500–700 per 100,000 population, according to new data from the [U.S.] and Europe, [which is] higher than the annual incidence of new cases of cancer.”
It goes on to say that “[t]he majority of deaths from sepsis are preventable and can be reduced by 50 percent with appropriate measures.”
This global event aims to put pressure on the WHO; they need to provide adequate resources to member states to help them implement better ways to manage sepsis. The protocols that were introduced in New York State may help guide future interventions to monitor and reduce risk.