what is sepsis?
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Confidential
What is Sepsis?Damian Mingle
What is Sepsis?Damian MingleWPC Healthcare
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The Severity of SepsisWhat lies beneath the healthcare cost and mortality ratesNotable Fact Details
High cost to treat Most expensive condition treated in the United States $23.7B
High ICU costs 40% of all ICU costs
High mortality rate 60% for septic chock
High readmission rate 62%
Rapid decline Move to septic shock within 36 hours of identification
Challenging No standard diagnostic test, often appears with no co-morbid conditions
SOURCE: Gary T, Mingle D, Yenamandra A (2016) The Evolving Definition of Sepsis. Int Clin Pathol J 2(6): 00063. DOI: 10.15406/icpjl.2016.02.00063
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The Evolving Definition and Monitoring of SepsisShifting overtime
Stage 1: SIRS Stage 2: Sepsis Stage 3: Severe Sepsis
Stage 4: Septic Shock
Mortality Rate 7% 16% 40% > 50%
Clinical Indicator Flu-like symptoms SIRS + infection Sepsis + signs of organ failure
Persistent severe sepsis
When stage was used to define sepsis
1989-2015 Sepsis-1 & -2
1915-1989 Pre-Sepsis-1
2016 – present Sepsis-3
400BC – 1917 Hippocrates
Challenges for each stage
Misidentification: inflammation could be due to a wide variety of other medical conditions.
Time: It could take days to verify source of infection.
Treatment: Limited treatment options when organs begin to fail.
High mortality rate: Often too late for successful treatment.
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Sepsis-1Key outcomes
• Establishment of the term “systemic inflammatory response syndrome” (SIRS)• No definable presence of bacterial infection was required to diagnose sepsis• The terms “severe sepsis” and “septic shock” were introduced to differentiate
degrees of severity
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Sepsis-2Key outcomes
• Recognized the sepsis-1 definition has limitations• Expanding the list of diagnostic criteria for sepsis• Recognized the separate characteristics or stages of sepsis designated by the
acronym PIRO: predisposition, infection, response to the infectious challenge, and organ dysfunction
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Sepsis-3Key outcomes
• Sepsis is a life-threatening organ dysfunction caused by a deregulated host response to infection.
• Septic shock is a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associate with a greater risk of mortality that with sepsis alone.
• Introduces a new diagnostic tool, qSOFA
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What is qSOFA?Predicting poor outcomes in infection patients
Criteria Point Value
Altered mental status +1
Respiratory rate > or = 22 +1
Systolic blood pressure < or = 100 +1
qSOFA scoring
A qSOFA score of > or = 2 suggest a high-risk of poor outcome and an indication that these patients have sepsis and should have their lactate levels tested for evidence of organ dysfunction.
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Controversy Surrounding Sepsis-3Raising concerns
• Focus on adult patients without including newborn and pediatric patients• Research was generate from patients in the U.S. and Europe, but not from
economically poorer countries• No experts from emergency medicine or other important groups to weigh in• The lack of comparison to the prior 25-year body of sepsis research (which focused
on 4 clinical stages and the new stages have been reduced to two)• A significant reliance on qSOFA to diagnose sepsis• Missing endorsements by all societies (i.e. Latin American Sepsis Institute,
American College of Chest Physicians, and American College of Emergency Physicians).
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Beyond ControversyData Science Solution
While several hospitals use computer algorithms to monitor patients, these are almost exclusive to the following scenarios:• Using electronic medical records• Monitoring vitals• Focusing on ICU patients
…results in these areas are wonderful, however, we should consider other approaches…
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Sepsis Through the Eyes of Data ScienceTwo Primary Reasons for Our Success
1. For patients, “time is tissue”. Mortality is not the only measurement for sepsis performance, but “quality of life” for a patient.
2. Almost all sepsis cases have come to the hospital via the emergency department, however many diagnostic criteria are not met until hours or days after first arrival.
Interested in results from our implemented solution? Send us a note.We are expanding our network of hospital partners.
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