Screening for Sepsis Could Save Lives, Researchers Say

Sepsis (including severe sepsis and septic shock) is not only a leading killer in the general surgery and ICU populations. Over 750,000 cases will occur in the US each year, resulting in more than 215,000 deaths. It kills more people annually than lung cancer, colon cancer, or breast cancer, and yet it still is not high on the list of suspicion in many cases, especially in the ER. Patients who survive sepsis often have reduced quality of life because of permanent organ damage, amputation, etc., and have a reduced life expectancy overall.

The best hope for a septic patient right now is early recognition and rapid goal-directed therapy. The sepsis bundles available for doctors at survivingsepsis.com go a long way to improving sepsis recognition and care. The reality is, though that sepsis can be difficult to diagnose, and a pathogen may only be cultured and identified in 30 - 70% of cases, depending on which study you read and the nature of the infection. (BTW, sepsis is NOT just "blood poisoning" [septicemia]; it can also develop from a local infection.) Biomarkers such as procalcitonin (PCT) can improve the ability to diagnose sepsis correctly by 25% or more, and are also prognostic for severity of the disease. PCT levels rise early in the course, so that the disease can be recognized early in sepsis when it is infinitely more treatable, than in severe sepsis or septic shock. The current marker of choice, serum lactate, doesn't rise until the patient is hypoxic (has low oxygen levels), which can mean that they may have already also suffered some organ/tissue damage -- that's too late, in my mind.

Other potential markers for sepsis include several of the interleukins, which also rise early as part of the inflammatory response. At least one study has shown that a rise in IL-6 can help predict neonatal sepsis 1 - 2 days before other symptoms become apparent. In some hospitals in Europe, doctors evaluate IL-6 levels of trauma patients to determine if they're level of inflammation has subsided enough to reduce sepsis risk prior to surgery.

US doctors need to pursue more education on this topic and become early adopters of biomarkers as they become available. It's time for patients, like Dr. Flatley's daughter, to stop dying needlessly.

Roma Levy of CA 9:14PM July 21, 2010