New Study: Sepsis-Related Deaths in U.S. Hospitals May Not Be Preventable

New Study: Sepsis-Related Deaths in U.S. Hospitals May Not Be Preventable

At least 1.7 million adults in the United States develop sepsis each year, according to the Centers for Disease Control and Prevention (CDC), and nearly 270,000 die annually as the result of sepsis.

One in three patients who die in hospitals has sepsis, which makes this serious and potentially fatal medical condition a significant concern for nurses and others providing patient care. Nurses, administrators, health care organizations, and researchers continuously look for ways to prevent these deaths. Campaigns, such as the Surviving Sepsis Campaign and the Sepsis Alliance, support rapid diagnosis and treatment of sepsis to improve patient outcomes. The contribution of sepsis to these inpatient deaths – and the extent to which they may be prevented – is largely unknown.

The results of a new study suggest that most of these deaths are not preventable.

Study Sheds Light on the Prevalence, Preventability of Sepsis-related Deaths

The researchers reviewed the medical records of 568 patients who were admitted to six hospitals and who died in the hospital or who had been discharged to hospice and not readmitted. The scientific team identified sepsis in 300 of those hospitalizations, which is 52.8 percent of admissions. Nearly 51 percent of the participants were male; the median age of participants was 70.5 years.

They used a standardized form to review the records for several factors, such as the presence of sepsis, clinical comorbidities, cause of death and any indications of suboptimal care for sepsis. The team then considered these factors, along with the patient’s own goals of care as measured by an adapted Likert scale, to evaluate the preventability of each sepsis-related death.

The reviewers used the Surviving Sepsis Campaign guidelines to define best practices in the prevention and care of sepsis.

End-stage comorbidities were present on admission in 121 of the 300 of those with sepsis who died. The most common were progressive or metastatic solid cancer at 20 percent, refractory hematologic cancer at 5.3 percent, severe debilitating dementia at 5.0 percent, severe debilitating stroke at 4.0 percent, and severe chronic lung disease at 4.0 percent.

The Results

The researchers determined that sepsis directly caused death in 198 cases, or 34.9 percent of hospitalization. The team found that only 3.7 percent of these sepsis-related deaths were definitely or moderately preventable – severe chronic comorbidities were, in fact, the underlying causes for most of these deaths. They interpreted the results as meaning that better hospital care would not have prevented most of these deaths.

The results of the study confirm the high prevalence of sepsis in hospitals and its contribution to mortality in these settings. In this study, sepsis was present in more than half of terminal hospitalizations and was the immediate cause of death in more than one-third.

The analysis showed that, from the standpoint of hospital-based care, nearly 90 percent of sepsis-associated deaths were unpreventable. Specifically, the researchers judged 3.7 percent of deaths as definitely or moderately likely preventable, and another 8.3 percent as possibly preventable.

There were no indications of suboptimal care in 77.3 percent of the study cases. The most common problems associated with the remaining 22.7 percent of cases were associated with delays in the administration of antibiotics or in controlling the source of the infection.

Despite high clinical awareness and the prompt delivery of quality care, the prevention of death from sepsis remains elusive. Comorbidities and other underlying features of the patient may be the main reason for this. Many of the patients included in the study had severe comorbidities, such as cancer, chronic heart disease, and chronic lung disease. Furthermore, many patients expressed goals of care upon admission that did not allow for aggressive care. Lastly, some patients included in the study had been so severely ill from sepsis upon admission that nothing further could be done.

“Sepsis is a leading cause of death,” said Chanu Rhee, MD, MPH, lead author and critical care physician at the Brigham, “but since most of these deaths are occurring in very complex patients with severe comorbidities, many of them may not be preventable with better hospital-based care. For me, as a critical care physician, that resonated with what I see in my clinical practice. A lot of sepsis patients we treat are extremely sick, and even when they receive timely and optimal medical care, many do not survive. It was important for me to see that borne out of the more rigorous study we did.”

This coincides with what the CDC and other health organizations already know. More than 90 percent of adults and 70 percent of children who develop sepsis have a health condition that increases their risk of sepsis, according to the CDC. Sepsis develops most often in those over the age of 65, under the age of 1, and in those with weakened immune systems or chronic medical conditions.

Rhee and her team hope to replicate their findings and expand their understanding of the preventability of sepsis-associated deaths using information from different hospitals. Furthermore, they hope to determine whether better preventive care before hospitalization could help reduce the number of sepsis-related deaths occurring in hospitals and elsewhere.

“The point of this study is not to diminish the importance of sepsis quality-improvement issues in hospitals — even one preventable death is too much,” Rhee said. “In addition, since we only reviewed medical records for patients who died, our study doesn’t highlight all the other patients with sepsis for whom timely recognition and care in the hospital actually did prevent death. One of the takeaways, however, is that further innovation in the prevention of underlying conditions might be necessary before we can see a really large reduction in sepsis mortality.”

The researchers published their study in JAMA Network Open, the new online-only open access general medical journal from the Journal of the American Medical Association’s JAMA Network.

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