Death rates from sepsis have stalled, contrary to previous analyses that showed mortality falling, according to new research conducted in part by University of Pittsburgh Department of Critical Care Medicine scientists. The finding, announced in the Journal of the American Medical Association, coincided with World Sepsis Day.
On the heels of the dismal news, a newly funded project at Pitt seeks to find out if policy-driven changes to hospital care may be able to reverse this trend and save lives. The results could impact regulations being crafted in multiple states, including Pennsylvania.
“Sepsis is a public health crisis,” said Dr. Jeremy Kahn, professor of critical care medicine and health policy and management at Pitt. “It is extremely appropriate to address a public health crisis through regulation. However, regulations can have unintended consequences, and when it comes to sepsis – a complicated condition – it is important to get it right.”
Sepsis arises when the body’s response to an infection injures its own tissues and organs. It is the leading killer of hospital patients. According to the Centers for Disease Control and Prevention, more than 1.5 million people get sepsis each year in the United States.
Kahn was recently awarded a $1.5 million grant from the U.S. Department of Health and Human Services to conduct a four-year study analyzing Rory’s Regulation, which put a protocol in place for New York hospitals to follow when confronted with potential sepsis cases. The regulation was instituted following the tragic and widely publicized death of Rory Staunton, 12, from sepsis. Kahn and his team will dive into data collected on patient outcomes as a result of the regulation and conduct in-depth observations of how clinicians enact the protocols in order to determine what aspects of the regulation work and what, if any, may be potentially costly and time-consuming without saving lives.
According to the JAMA study – which was led by doctors at Brigham & Women’s Hospital and analyzed records for nearly 8 million adult patients hospitalized throughout the U.S., including more than 500,000 at UPMC, between 2009 and 2014 – the incidence of sepsis and related death rates have remained stable, contrary to previous estimates made using insurance claims data. In 2014, 6 percent of patients admitted to the hospital had sepsis and, of these, 15 percent died in-hospital.
“This is a benchmark finding,” said co-author Dr. Christopher Seymour, assistant professor in Pitt’s departments of Critical Care Medicine and Emergency Medicine. “With recent advances in our understanding of sepsis, and various state protocols aimed at reducing sepsis rates, it is surprising that we’re seeing such flat trends. We need to take a look in the mirror and ask what we can do differently.”
Both Seymour and Kahn are members of Pitt’s Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, which takes a multidisciplinary approach to studying optimal care of critically ill people, including those with sepsis. Research conducted at CRISMA has made Pitt an international leader in critical care, and its scientists rewrote the definition of sepsis.
Earlier this year, Seymour led the first scientific analysis of Rory’s Regulation, finding that – when it comes to quick administration of much of the requirements, such as giving antibiotics and testing for infection – the regulation works to save lives. However, Seymour’s analysis gave rise to questions, including whether the requirement to quickly administer IV fluids was helpful, something Kahn plans to explore with his new grant.
“New York is at the vanguard,” Kahn said. “The Rory Staunton Foundation is committed to having policies for sepsis treatment in every state. Our hope is that our analysis is going to inform those policies by saying: Here’s the way Rory’s Regulation helped; here’s how it might not have been effective, and here’s how it could be improved.”