Sepsis occurs in 6% of US hospitalizations but is holding steady

Sepsis, a life-threatening syndrome that involves multi-organ failure and infection, is a costly outcome frequently seen during hospitalizations. A study published yesterday in JAMA used electronic medical records, and not claims data, to determine that sepsis occurs in about 6% of all US hospitalizations.

"Over the last decade there have been a number of studies suggesting that the rates of sepsis were rising in the US," said Chanu Rhee, MD, MPH, assistant professor at Harvard University, in an interview. "But we suspected this may be an artifact related to changing diagnoses and coding practices."

Data on almost 3 million patients

To test this theory, Rhee and colleagues from Brigham and Women's/Children's Hospital in Boston analyzed data from nearly 3 million patients admitted to 409 US hospitals in 2014. To qualify as a sepsis case, the records had to meet a specific definition, including concurrent indicators of infection (blood culture draws and antibiotic prescribing) and organ dysfunction (initiation of vasopressors, mechanical ventilation, and/or changes in laboratory tests).

"There is not a single confirmatory diagnostic test for sepsis," said Rhee. "So we designed a definition that would be easily found in electronic health data."

Rhee and his colleagues found that 6% of all hospitalizations experience sepsis, and sepsis occurred in more than one in three hospitalizations (35%) that resulted in the death of a patient. More important, an analysis of sepsis cases from 2009 to 2014 using the researchers' definition showed no increase in sepsis cases. Instead, the 6% number remained steady.

"This in no way diminished the seriousness of sepsis," said Rhee. "But we need objective and efficient surveillance methods to direct our efforts."

The team found that 54.7% of sepsis patients included in the study required treatment in the intensive care unit for an average of 5 days. According to an accompanying editorial in JAMA, the cost of treating sepsis in US hospitals in 2013 was $24 billion, which makes it the most expensive condition treated in US hospitals.

Rhee said the current study looked at adult sepsis patients only, and follow-up should be conducted with a pediatric patient population.

Global focus on maternal sepsis

Though the JAMA study focused on US hospitals, sepsis is a costly problem worldwide. Yesterday the World Health Organization (WHO) observed World Sepsis Day with a renewed focus on maternal and child sepsis cases.

Maternal sepsis is sepsis experienced during pregnancy, birth, recovery, or abortion. About 35,000 maternal sepsis deaths occur each year, almost all preventable, the WHO said.

When sepsis as a primary or contributing cause is factored in, the condition can be tied to as many as 100,000 maternal deaths a year. In addition, sepsis kills about 1 million newborn babies every year.

Currently the WHO and its partners are working on a large multi-country study on maternal sepsis in more than 500 health facilities in 54 countries, in order to better understand the prevalence of maternal sepsis.

See also:

Sep 13 JAMA study

Sep 13 JAMA editorial

Sep 12 WHO press release

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