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Twice as many people are dying from sepsis worldwide than previously estimated, according to a groundbreaking study by an international team of scientists published in The Lancet today. Among them are a disproportionately high number of children in poor areas.
This study, the most comprehensive clinical study on sepsis to date, revealed 48.9 million cases of sepsis in 2017 and 11 million deaths. 1 in 5 deaths globally are associated with sepsis. 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. For sepsis survivors, it can create lifelong disabilities and suffering.
It was found that about 85% of sepsis cases occurred in low- or middle-income countries – especially in Sub-Saharan Africa, the South Pacific islands, and South, East, and Southeast Asia. While sepsis incidence is higher among females than males, more than 40% of all cases are occurring in children under 5.
“I’ve worked in rural Uganda, and sepsis is what we saw every single day. Watching a baby die of a disease that could have been prevented with basic public health measures really sticks with you. I want to contribute to solving this tragedy, so I participate in research on sepsis. However, how can we know if we’re making progress if we don’t even know the size of the problem? If you look at any top 10 list of deaths globally, sepsis is not listed because it hasn’t been counted.” — LEAD AUTHOR KRISTINA E. RUDD, M.D., M.P.H., ASSISTANT PROFESSOR AT PITT’S DEPARTMENT OF CRITICAL CARE MEDICINE
For their analysis, Rudd and colleagues leveraged the Global Burden of Disease Study, a comprehensive epidemiological analysis coordinated by the Institute for Health Metrics and Evaluation (IMHE) at the University of Washington School of Medicine. Previous global estimates for sepsis relied upon hospital databases from select middle- and high-income countries, making them severely limited and prone to overlooking the occurrence outside of the hospital, especially in low-income countries.
“We are alarmed to find sepsis deaths are much higher than previously estimated, especially as the condition is both preventable and treatable. We need renewed focus on sepsis prevention among newborns and on tackling antimicrobial resistance, an important driver of the condition.” — SENIOR AUTHOR MOHSEN NAGHAVI, M.D., PH.D., M.P.H., PROFESSOR OF HEALTH METRICS SCIENCES AT IHME AT THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Although the number of cases are much higher than previously estimated, it is important to note that great international and collaborative work has been done worldwide in the past decades to fight sepsis. These efforts are conveyed in the study which examined annual sepsis incidence and mortality trends from 1990 to 2017. The study found that rates are actually decreasing. In 1990, there were an estimated 60.2 million sepsis cases and 15.7 million deaths, compared to the 48.9 million cases and 11 million deaths in 2017. However, the study highlights we still have a long way to go in the global fight against sepsis and we need to continue to build upon the work being done worldwide.
“This research confirms the urgent need for policymakers, healthcare providers, clinicians, and researchers to work together to implement robust national sepsis strategies, as called for in the 2017 WHO Resolution on Sepsis.” — KONRAD REINHART, PRESIDENT GLOBAL SEPSIS ALLIANCE
To access the full study please see: The Lancet Global Burden of Disease Study into Sepsis
For the Australian Sepsis Network media release in response to the study please see: ASN Media Release – Prof Finfer
For the Global Sepsis Alliance media release and Q&A please see: GSA Press Release
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Treating sepsis patients with steroids leads to quicker recovery and reduces the number of blood transfusions needed, according to ADRENAL – the largest ever international clinical trial on septic shock.
A team of researchers from The George Institute for Global Health – including Professor Simon Finfer of the Australian Sepsis Network – studied whether the use of steroids in treating patients with septic shock would improve outcomes.
Septic shock occurs when sepsis causes dangerously low blood pressure, leading to increased risk of organ failure or death.
The results of the ADRENAL study, involving 3800 patients and published in the New England Journal of Medicine on 19 January, found that steroids reduced the duration of septic shock and the frequency of blood transfusions needed, and decreased the time spent in intensive care. However, the use of steroids as an additional treatment for septic shock did not reduce deaths.
The study lead, Professor Bala Venkatesh of The George Institute, said “Our results show there is still a lot to learn about septic shock which kills up to half of those affected in some parts of the world. But, we have finally shown what part steroids play in the treatment of these patients. If we can reduce the time spent in intensive care units that not only frees up space for other patients, it saves health systems worldwide a huge amount of money.”
The use of steroids to treat septic shock has been accepted practice for more than 50 years, however clinicians were uncertain about the best dose of duration of steroids given to patients.
The ADRENAL trial has shown that although steroids do not reduce death rates in septic shock, their use as an additional treatment led to faster resolution of septic shock, decreased time on mechanical ventilation, and earlier discharge from intensive care.
Study investigator and co-author Professor John Myburgh, of The George Institute, noted “Anyone can get sepsis, young, old, fit and healthy. It does not discriminate. In Australia up to a quarter of people who get septic shock will die with more people losing their lives annually than the road toll.
“It is essential that we raise awareness of this disease so people can get treatment more quickly, but we will also need to find better and more effective care for those who go into septic shock.”
The full study paper is available in the New England Journal of Medicine.
Septic shock is a serious complication of sepsis, affecting 15 thousand Australians annually, with a global mortality rate of up to 50%. Occurring when blood pressure is dangerously low, septic shock starves organs and can rapidly lead to multiple organ failure or death. Adding to the severity of the condition is that some patients respond to treatment, and others do not.
Professor David Evans of the University of Queensland (UQ) is tackling this issue using genomics. Professor Evans and his team at the Diamantina Institute are developing a library of genetic markers to determine if our genetic make-up might influence the severity of infections and our response to treatments. The team hopes to develop a model that will predict chances of survival for sepsis patients based on their genetic profile, and reduce multiple organ failure and death from septic shock.
Working alongside Professor Evans and his team is Professor Bala Venkatesh, critical care specialist and Australian Sepsis Network (ASN) collaborator. Professor Venkatesh leads the ADRENAL trial – the largest septic shock study to date – is comparing intravenous hydrocortisone with placebo for patients with septic shock. Previous studies on corticosteroids have provided conflicting results about the drug’s efficacy as a treatment for septic shock. Professor Venkatesh is examining whether hydrocortisone is beneficial only to some patients who are critically ill with septic shock, and Professor Evans’ work may identify those patients via their genetic markers.
With the average cost of treating septic shock being more than $40,000 per episode, trials like this have considerable outcomes for Australian health expenditure as well as potentially informing the future of treatment for septic shock.
To mark World Sepsis Day, the Global Sepsis Alliance has produced a short video explaining what sepsis is, and how to identify and treat it.
Please share this video with friends, family, and colleagues. It may one day save their lives.
Sepsis is caused by the body’s overwhelming and life-threatening response to an infection and requires rapid intervention. It begins outside of the hospital for nearly 80 percent of patients. (more…)