GSA urges treatment of sepsis as a medical emergency

Oct 1 2010

The Global Sepsis Alliance (GSA) is urging healthcare providers, patients and policymakers worldwide to treat sepsis as a medical emergency.  "Tens of millions of people die from sepsis each year, making it the likely leading cause of death worldwide.  Sepsis kills regardless of age, ethnicity, location and access to care," said Konrad Reinhart, M.D., Chairman of the GSA and director of the Department of Anesthesiology and Intensive Care Medicine, University Hospital of the Friedrich Schiller, University of Jena, Germany.  "It's imperative that we come together as a global community to address this enormous public health problem," added Mark Lambert, executive director of the GSA.

The GSA, which represents approximately 250,000 intensive and critical care physicians around the world, announced this call to action at the conclusion of the Merinoff Symposium, an international sepsis conference sponsored by the Feinstein Institute for Medical Research, part of the North Shore-LIJ Health System in Manhasset, NY.

Sepsis, the body's life-threatening response to infection, afflicts approximately 750,000 Americans each year and costs the healthcare system in the U.S. nearly $17 billion.  It causes more deaths per year than prostate cancer, breast cancer and HIV/AIDS combined. Globally, an estimated 18 million cases of sepsis occurs each year. In fact, experts in the field believe sepsis is actually responsible for the majority of the mortality associated with HIV/AIDS, malaria, tuberculosis, pneumonia and other infections acquired in the community, in healthcare settings and by traumatic injury.

At the Merinoff Symposium, more than 150 sepsis experts from 18 countries supported a declaration that urged the medical community to "recognize sepsis as a medical emergency requiring the administration of fluids, antibiotics and other appropriate treatments of infection within one hour of suspicion of sepsis." Attendees called for new studies to generate data demonstrating the efficacy of this approach and confirming sepsis as the common pathway to death and a leading cause of death worldwide.

Conference participants also tackled one of the more difficult challenges associated with sepsis -- confusion over what it is – by ratifying a new public definition:  

"In order to make sepsis a global health priority, the first step is to define it in terms the public can understand. This definition achieves this goal," said Edgar Jimenez, M.D., president of the World Federation of Societies of Intensive and Critical Care Medicine and director, Medical Critical Care, Orlando Regional Medical Center, who added that multiple surveys show that as high as 50 to 60 percent of individuals around the world are unfamiliar with sepsis.  More specifically, a recent Feinstein Institute-sponsored survey of 1,000 Americans showed that 60 percent of respondents were not familiar with the term, and the lack of familiarity was greatest among seniors, men and African-Americans, all of whom are at increased risk of sepsis.

"In the U.S., one in four hospital deaths is caused by sepsis, yet the majority of Americans have never even heard of the condition. Sepsis is a mystery to most Americans," said Kevin J. Tracey, M.D., president of the Feinstein Institute.  "The lack of awareness and understanding is one of the major challenges we face in health care today."

Sepsis occurs more frequently in the young and the elderly, and in many hospitals, sepsis is the leading cause of death in non-coronary intensive care units. In addition, anti-cancer drugs frequently render oncology patients susceptible to infection, and sepsis is a major cause of death in this population.  While physicians and nurses in intensive care units more often understand the risk of sepsis in seriously ill patients, healthcare professionals in other settings are often less aware and ill-prepared to recognize and deal with sepsis as a medical emergency.  "Focusing on sepsis as an emergency is even more critical in the developing world where there are so few ICUs and sepsis is the cause of death for many as 7 out of 10 children worldwide," says Niranjan "Tex" Kissoon, M.D., president-elect of the World Federation of Pediatric Intensive and Critical Care Societies, associate head and professor, Division of Critical Care, Department of Pediatrics, University of British Columbia, vice president, Medical Affairs, BC Children's Hospital.

Sepsis is under-recognized and poorly understood as a leading cause of death in the world due to confusion about its definition among patients and healthcare providers, lack of documentation of sepsis as a cause of death on death certificates, inadequate diagnostic tools, and inconsistent application of standardized clinical guidelines to treat sepsis. "There is hope," concludes Dr. Reinhart. "Available interventions (e.g., fluids, antibiotics and other appropriate treatments of infection) can dramatically alter the course of sepsis and improve survival if administered within the first hour of suspicion of sepsis."