Incidence of Sepsis Stable, But Mortality Remains High

MedicalResearch.com Interview with:

Dr. Chanu Rhee MD, Assistant Professor Therapeutics Research and Infectious Disease Epidemiology Group Department of Population Medicine at Harvard Medical School / Harvard Pilgrim Health Care Institute Critical Care and Infectious Disease Physician Transplant/Oncology Infectious Disease service and Medical Intensive Care Unit at Brigham and Women’s Hospital

Dr. Rhee

Dr. Chanu Rhee MD, Assistant Professor
Therapeutics Research and Infectious Disease Epidemiology Group
Department of Population Medicine at Harvard Medical School / Harvard Pilgrim Health Care Institute
Critical Care and Infectious Disease Physician
Transplant/Oncology Infectious Disease service and
Medical Intensive Care Unit at Brigham and Women’s Hospital 


MedicalResearch.com: What is the background for this study?

Response: Multiple studies suggest that the incidence of sepsis, the syndrome of life-threatening organ dysfunction caused by infection, is increasing over time, while mortality rates are decreasing.  However, reliably measuring sepsis incidence and trends is challenging because clinical diagnoses of sepsis are subjective and insurance claims data, the traditional method of surveillance, can be affected by changing diagnosis and coding practices over time.

In this study, my colleagues and I estimated the current U.S. burden of sepsis and trends using clinical data from the electronic health record systems of a large number of diverse hospitals. The findings, published in JAMA, challenge the use of claims data for sepsis surveillance and suggest that clinical surveillance using electronic health record data provides more objective estimates of sepsis incidence and outcomes.

MedicalResearch.com: What are the main findings?

Response: Specifically, we identified sepsis from electronic clinical data using concurrent indicators of infection (blood culture draws and antibiotic prescribing) and organ dysfunction (initiation of vasopressors, mechanical ventilation, and/or changes in laboratory tests).  We applied this definition to electronic health record data from nearly 3 million patients admitted to 409 US hospitals in 2014.

We found that sepsis was present in 6% of all hospitalizations, and 21% of these patients died or were discharged to hospice.  Overall, sepsis was present in more than one third of all hospitalizations that ended in death.  We used these data to project the total U.S. burden of sepsis in hospitalized patients in 2014, and we estimated that there were approximately 1.7 million sepsis cases nationwide, of whom 270,000 died.

In addition, we assessed whether sepsis incidence and outcomes have been changing over time.  In contrast to claims-based estimates, we found no significant changes in adult sepsis incidence or in the combined outcome of hospital death or discharge to hospice between 2009 and 2014.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Our findings of stable sepsis incidence and outcomes do not diminish the importance of sepsis.  On the contrary, our study demonstrates that the burden of sepsis is very high and likely contributes to a large number of deaths in the United States.

More work needs to be done to better prevent and treat this condition.  In addition, though, our study shows that we need objective and efficient surveillance methods to direct and understand the impact of our efforts.”

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We recommend that routine sepsis surveillance efforts shift from claims data to clinical data from electronic health record to help health professionals, hospitals, and policy makers gain a better understanding of sepsis incidence, outcomes, and trends.  This knowledge is essential to inform better treatment and prevention policies.  Further research is also needed to study the burden of sepsis in the pediatric population, the preventability of deaths in patients with sepsis, and optimal risk adjustment methods for comparison of sepsis outcomes between hospitals using clinical data.

Disclosures: This research was funded by the CDC Prevention Epicenter Program, and in part by the Agency for Healthcare Research and Quality, the National Institutes of Health, Department of Veterans Affairs, and intramural funding from the National Institutes of Health Clinical Center and National Institute of Allergy and Infectious Diseases. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, Kadri SS, Angus DC, Danner RL, Fiore AE, Jernigan JA, Martin GS, Septimus E, Warren DK, Karcz A, Chan C, Menchaca JT, Wang R, Gruber S, Klompas M, for the CDC Prevention Epicenter Program. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. Published online September 13, 2017. doi:10.1001/jama.2017.13836

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

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upcoming JAMA publication:

Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014

CRHEE@BWH.HARVARD.EDU

 

 

Bethlihem_Gebremedhin@harvardpilgrim.org