New Definition of Sepsis May Improve Treatment

Hospital trims mortality by more than 75% with standardized protocols

Physicians at the University of Pittsburgh Medical Center and the University of Pittsburgh School of Medicine (UPSM) are helping to rewrite the clinical rule book on sepsis, a major patient killer in hospitals.

An international task force has published articles in the Journal of the American Medical Association that update definitions for sepsis and septic shock. Those definitions were last updated 15 years ago. The new definitions came from research conducted at UPSM. In related articles published in Critical Care Medicine, Pitt scientists describe how the new definitions can be used to help patients with sepsis.

“Put simply, sepsis is a life-threatening organ dysfunction due to a dysregulated response of the patient’s immune system to infection,” Dr. Derek C. Angus, chair of Pitt’s Department of Critical Care Medicine, said in a statement. “Our intent is that this definition results in greater consistency for epidemiologic studies, clinical trials, and—perhaps most important—better recognition and more timely management of patients with, or at risk of developing, sepsis.”

“This is the one of the largest collaborative studies ever conducted in the field of critical care medicine,” said Dr. Christopher W. Seymour, assistant professor in Pitt’s departments of Critical Care Medicine and Emergency Medicine. “The study results and Task Force Consensus definitions are endorsed by more than 25 professional medical and academic societies around the globe. And as doctors and hospitals adopt the updated definition, there is the potential to more promptly recognize thousands of patients at risk of becoming, or who already are, septic.”

In related news, providers at Dartmouth–Hitchcock Medical Center in Lebanon, New Hampshire, used a $26 million grant from the Centers for Medicare and Medicaid Services to reduce sepsis mortality by more than 75%, according to an article posted on the Stat News website.

“The solution wasn’t fancy; there was no code to break,” writes Dartmouth–Hitchcock President and CEO James N. Weinstein, MD. “We simply made sure that all clinicians were aware of the warning signs of sepsis and set a low threshold for starting treatment.”

That meant taking the following steps within three hours of suspecting that someone might have sepsis:

  • Obtaining a blood sample to measure lactate, a byproduct of turning blood sugar into energy. A high serum lactate level is a sign of severe metabolic distress.
  • Culturing the blood to identify infection.
  • Starting the patient on a broad-spectrum antibiotic.
  • Keeping the patient well hydrated.

The facility’s use of this “three-hour bundle” approach went from 0% to 90% over a three-month period, Weinstein writes. At the same time, deaths from sepsis dropped by more than 75%.

Sources: Pittsburgh Business Times; February 22, 2016; and Stat News; February 22, 2016.