A recent editorial in the journal Lancet entitled “Sepsis Hysteria” questioned the increasing focus on sepsis, commenting that “sepsis only develops in a tiny minority of patients,” and that severe cases are rare.1 Unfortunately, there is a lot of evidence to the contrary. Findings of a large study recently published in The Lancet provide more evidence that sepsis is indeed a very significant problem.
In the most comprehensive study of international sepsis incidence to date, the authors found that over 20% of worldwide deaths are ultimately caused by sepsis, over twice the previously estimated global impact.2 Sadly, children under 5 account for over half of these sepsis deaths, and those in lower income countries are disproportionately affected. The good news is that the study showed a trend toward fewer cases and lower mortality over the same time period. This is likely due to improved public health and disease prevention in the developing world, as well as better recognition and timely treatment of sepsis. Nevertheless, this study underscores the severity that sepsis presents, both in terms of disease prevalence and outcomes.
Two other recent studies focused on the US have shown that 30-50% of in-hospital deaths are related to sepsis, further emphasizing the point that sepsis is a major public health problem.3,4
As the Global Sepsis Alliance notes in its helpful commentary on the recent Lancet study, sepsis may actually be more common than previously thought, and efforts at prevention, recognition, and effective treatment can have a major impact. They also highlight the recent statement from the World Health Organization, which emphasizes the need for treating sepsis as an emergency that requires time-critical action.
Unless sepsis is recognized and treated quickly it can result in rapid patient deterioration, organ failure, and death. Multiple studies document that when sepsis is viewed as a true medical emergency, immediate and relatively simple interventions such as early adequate fluid resuscitation and antibiotics improve outcomes and save lives.5–9 The recent Lancet article reminds us of the need for continued education of clinicians and the public about the signs of sepsis and the need for early treatment.
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- Singer M, Inada-Kim M, Shankar-Hari M. Sepsis hysteria: excess hype and unrealistic expectations. Lancet. 2019;394(10208):1513-1514. doi:10.1016/S0140-6736(19)32483-3
- Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-211. doi:10.1016/S0140-6736(19)32989-7
- Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA. 2014;312(1):90-92. doi:10.1001/jama.2014.5804
- Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014. JAMA. 2017;318(13):1241-1249. doi:10.1001/jama.2017.13836
- Liu VX, Morehouse JW, Marelich GP, et al. Multicenter Implementation of a Treatment Bundle for Patients with Sepsis and Intermediate Lactate Values. Am J Respir Crit Care Med. 2016;193(11):1264-1270. doi:10.1164/rccm.201507-1489OC
- Rhodes A, Phillips G, Beale R, et al. The Surviving Sepsis Campaign bundles and outcome: results from the International Multicentre Prevalence Study on Sepsis (the IMPreSS study). Intensive Care Med. 2015;41(9):1620-1628. doi:10.1007/s00134-015-3906-y
- Leisman DE, Doerfler ME, Ward MF, et al. Survival Benefit and Cost Savings From Compliance With a Simplified 3-Hour Sepsis Bundle in a Series of Prospective, Multisite, Observational Cohorts. Crit Care Med. 2017;45(3):395-406. doi:10.1097/CCM.0000000000002184
- Leisman D, Wie B, Doerfler M, et al. Association of Fluid Resuscitation Initiation Within 30 Minutes of Severe Sepsis and Septic Shock Recognition With Reduced Mortality and Length of Stay. Ann Emerg Med. 2016;68(3):298-311. doi:10.1016/j.annemergmed.2016.02.044
- Kuttab HI, Lykins JD, Hughes MD, et al. Evaluation and predictors of fluid resuscitation in patients with severe sepsis and septic shock. Crit Care Med. 2019;47(11):1582-1590. doi:10.1097/CCM.0000000000003960